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1. Agreement Between Self-Reported Information and Administrative Data on Comorbidities, Imaging and Treatment in Denmark – A Validation Study of 38,745 Patients with Knee or Hip Osteoarthritis

Author: Selçuk H, Roos EM, Grønne DT, Ernst MT, and Skou ST
Subjects: self-report, data validity, osteoarthritis, denmark, Infectious and parasitic diseases, RC109-216
Abstract: Halit Selçuk,1 Ewa M Roos,2 Dorte T Grønne,2 Martin T Ernst,3 Søren T Skou2,4 1Department of Physiotherapy and Rehabilitation, Marmara University, &Idot;stanbul, Turkey; 2Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; 3Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark; 4The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Slagelse, DenmarkCorrespondence: Søren T SkouResearch Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 55 Campusvej, Odense, DK-5230, DenmarkTel +45 23 70 86 40Email stskou@health.sdu.dkPurpose: To validate self-reported information obtained from patients with knee or hip osteoarthritis (OA) in primary care against administrative data from the three national Danish registries.Patients and Methods: We compared the baseline and 12-month follow-up data from 38,745 patients with knee or hip OA participating in the Good Life with osteoArthritis in Denmark (GLA:D®) program with registry-based data on joint surgeries, pain medication dispensing, radiographs, and hospital diagnoses. Agreement was calculated using Cohen’s Kappa (k) and percentage agreement, both with 95% CI.Results: There was a moderate agreement between self-report and registry-based data for previous knee surgery (k=0.58, 84.99%) and a substantial agreement for previous hip surgery (k=0.73, 97.05%). Agreement varied from 0.05 to 0.95 and 84.99% to 99.94% for different types of surgeries with lowest agreement for collateral ligament surgery (k=0.05, 99.82%) and highest agreement for joint replacement (k=0.95, 99.54% for knee; k=0.95, 99.48% for hip). There was a moderate agreement (k=0.41, 81.59%) for knee and a slight agreement (k=0.20, 64.79%) for hip radiographs. Agreement varied from 0.01 to 0.53 and 65.39% to 99.90% for pain medication with lowest agreement for topical NSAID (k=0.01, 95.00%) and highest agreement for opioids (k=0.53, 92.56%). For comorbidities, agreement varied from 0.14 to 0.90 and 78.07% to 98.91%, with lowest agreement for anemia or other blood disease (k=0.14, 97.63%) and highest agreement for diabetes (k=0.90, 98.73%).Conclusion: As the most common types of pain medication used by patients with OA can be bought over-the-counter and as most OA patients are treated in primary care, which is often not covered by national registries, self-report of pain medication use and comorbidities is preferred but cannot be sufficiently validated against registry-based data. Future studies collecting self-reported information on joint surgery and pain medication from patients with OA should use a less detailed categorization to improve accuracy.Keywords: self-report, data validity, osteoarthritis, Denmark
Published: 2021

2. The Danish Diabetes Musculoskeletal Cohort: Non-Responder Analysis of an Electronic Survey Using Registry Data

Author: Boyle E, Folkestad L, Frafjord E, Koes BW, Skou ST, and Hartvigsen J
Subjects: diabetes, survey, non-participation analysis, musculoskeletal conditions, Infectious and parasitic diseases, RC109-216
Abstract: Eleanor Boyle,1 Lars Folkestad,2– 5 Erik Frafjord,6 Bart W Koes,1,7 Soren Thorgaard Skou,1,8 Jan Hartvigsen1,6 1Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; 2Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark; 3Department of Internal Medicine, Hospital of South West Denmark, Esbjerg, Denmark; 4Department of Clinical Research, University of Southern Denmark, Odense, Denmark; 5Open Patient Exploratory Network, University of Southern Denmark, Odense, Denmark; 6Chiropractic Knowledge Hub, Odense, Denmark; 7Department of General Practice, Erasmus MC, Rotterdam, the Netherlands; 8The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, DenmarkCorrespondence: Jan HartvigsenDepartment of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, Odense, 5230, DenmarkTel +45 65504522Email jhartvigsen@health.sdu.dkPurpose: To conduct a non-responder analysis on a musculoskeletal (MSK) electronic questionnaire.Methods: Individuals aged 18 years and older, diagnosed with diabetes mellitus (DM), and attended an ambulatory DM clinic formed the sample frame. They were invited to complete an electronic musculoskeletal (MSK) conditions and symptoms questionnaire booklet using a secured electronic email system. Individuals whose secured email box was not active at the time were discarded. Using the Central Person Registry number, a unique number assigned to all Danish residents, we linked the sample frame to different registries to learn more about non-responders. Non-responders were either individuals who did not respond to a single question and those who responded “No” to the first question about willing to participate. We calculated descriptive statistics for each characteristic. Univariate logistic regression models were conducted to determine the relationship between each characteristic and non-responder status.Results: The response rate was 36% (n = 3812). Individuals with type 2 DM (OR 2.0 (95% CI 1.8– 2.2)), secondary DM (1.9 (1.3– 2.8)) or unspecified DM (2.1 (1.8– 2.4)) were more likely to be non-responders than individuals with Type 1 DM. Also, individuals aged 70– 79 (1.3 (1.1– 1.6)) and 80 years and older (5.9 (4.5– 7.7)) were more likely to be non-responders than 18– 29 years old individuals. However, individuals aged 40– 49 (1.5 (1.2– 1.8)), 50– 59 (1.5 (1.3– 1.8)) or 60– 69 (1.4 (1.1– 1.6)) were more likely to be responders than 18– 29 years old individuals. Individuals with Charlson Comorbidity Index (CCI) of 1 (2.0 (1.3.2.9) or CCI of 2 (1.7 (1.1– 2.5) were more likely to be responders than individuals with a CCI of 0. Lastly, individuals who were currently outside of the workforce (1.6 (2.4– 2.9) or had unknown/missing socioeconomic status (3.9 (2.8– 5.3) were more likely to be non-responders than individuals who were working.Conclusion: Although we did find a non-response bias, this cohort will be an important source to determine the prevalence and consequences of MSK conditions in a secondary care DM population.Keywords: diabetes, survey, non-participation analysis, musculoskeletal conditions
Published: 2021

3. Burden of disease scenarios for 204 countries and territories, 2022-2050: a forecasting analysis for the Global Burden of Disease Study 2021

Author: Vollset, SE, Ababneh, HS, Abate, YH, Abbafati, C, Abbasgholizadeh, R, Abbasian, M, Abbastabar, H, Abd Al Magied, AHA, Abd ElHafeez, S, Abdelkader, A, Abdelmasseh, M, Abd-Elsalam, S, Abdi, P, Abdollahi, M, Abdoun, M, Abdullahi, A, Abebe, M, Abiodun, O, Aboagye, RG, Abolhassani, H, Abouzid, M, Aboye, GB, Abreu, LG, Absalan, A, Abualruz, H, Abubakar, B, Abukhadijah, HJJ, Addolorato, G, Adekanmbi, V, Adetunji, CO, Adetunji, JB, Adeyeoluwa, TE, Adha, R, Adhikary, RK, Adnani, QES, Adzigbli, LA, Afrashteh, F, Afzal, MS, Afzal, S, Agbozo, F, Agodi, A, Agrawal, A, Agyemang-Duah, W, Ahinkorah, BO, Ahlstrom, AJ, Ahmad, A, Ahmad, F, Ahmad, MM, Ahmad, S, Ahmed, A, Ahmed, H, Ahmed, S, Ahmed, SA, Akinosoglou, K, Akkaif, MA, Akrami, AE, Akter, E, Al Awaidy, S, Al Hasan, SM, Al Mosa, AS, Al Ta'ani, O, Al Zaabi, OAM, Alahdab, F, Alajlani, MM, Al-Ajlouni, Y, Alalalmeh, SO, Al-Aly, Z, Alam, K, Alam, N, Alam, T, Alam, Z, Al-Amer, RM, Alanezi, FM, Alanzi, TM, Albakri, A, Aldhaleei, WA, Aldridge, RW, Alemohammad, SY, Alemu, YM, Al-Gheethi, AAS, Al-Hanawi, MK, Ali, A, Ali, I, Ali, MU, Ali, R, Ali, SSS, Ali, VE, Ali, W, Al-Ibraheem, A, Alicandro, G, Alif, SM, Aljunid, SM, Alla, F, Almazan, JU, Al-Mekhlafi, HM, Alqutaibi, AY, Alrawashdeh, A, Alrousan, SM, Al-Sabah, SK, Alsabri, MA, Altaany, Z, Al-Tammemi, AB, Al-Tawfiq, JA, Altirkawi, KA, Aluh, DO, Alvis-Guzman, N, Al-Wardat, MS, Al-Worafi, YM, Aly, H, Alyahya, MS, Alzoubi, KH, Al-Zyoud, W, Amani, R, Ameyaw, EK, Amin, TT, Amindarolzarbi, A, Amiri, S, Amirzade-Iranaq, MH, Amu, H, Amugsi, DA, Ancuceanu, R, Anderlini, D, Anderson, DB, Andrade, PP, Andrei, CL, Andrei, T, Andrews, EA, Anil, A, Anil, S, Anoushiravani, A, Antony, CM, Antriyandarti, E, Anuoluwa, BS, Anvari, S, Anyasodor, AE, Appiah, F, Aquilano, M, Arab, JP, Arabloo, J, Arafa, EA, Arafat, M, Aravkin, AY, Ardekani, A, Areda, D, Aregawi, BB, Aremu, A, Ariffin, H, Arkew, M, Armani, K, Artamonov, AA, Arumugam, A, Asghari-Jafarabadi, M, Ashbaugh, C, Astell-Burt, T, Athari, SS, Atorkey, P, Atout, MMW, Aujayeb, A, Ausloos, M, Awad, H, Awotidebe, AW, Ayatollahi, H, Ayuso-Mateos, JL, Azadnajafabad, S, Azeez, FK, Azevedo, RMS, Badar, M, Baghdadi, S, Bagheri, M, Bagheri, N, Bai, R, Baker, JL, Bako, AT, Balakrishnan, S, Balcha, WF, Baltatu, OC, Barchitta, M, Bardideh, E, Barker-Collo, SL, Barnighausen, TW, Barqawi, HJ, Barteit, S, Basiru, A, Basso, JD, Bastan, M-M, Basu, S, Bauckneht, M, Baune, BT, Bayati, M, Bayileyegn, NS, Behnoush, AH, Behzadi, P, Beiranvand, M, Bello, OO, Belo, L, Beloukas, A, Bemanalizadeh, M, Bensenor, IM, Benzian, H, Beran, A, Berezvai, Z, Bernstein, RS, Bettencourt, PJG, Beyene, KA, Beyene, MG, Bhagat, DS, Bhagavathula, AS, Bhala, N, Bhandari, D, Bharadwaj, R, Bhardwaj, N, Bhardwaj, P, Bhargava, A, Bhaskar, S, Bhat, V, Bhattacharjee, NV, Bhatti, GK, Bhatti, JS, Bhatti, MS, Bhuiyan, MA, Bisignano, C, Biswas, B, Bjorge, T, Bodolica, V, Bodunrin, AO, Hashemi, MB, Basara, BB, Borhany, H, Bosoka, SA, Carvajal, AB, Bouaoud, S, Boufous, S, Boxe, C, Boyko, EJ, Brady, OJ, Braithwaite, D, Brauer, M, Brazo-Sayavera, J, Brenner, H, Brown, CS, Browne, AJ, Brugha, T, Bryazka, D, Bulamu, NB, Buonsenso, D, Burkart, K, Burns, RA, Busse, R, Bustanji, Y, Butt, ZA, dos Santos, FLC, Barsbay, MC, Calina, D, Campos, LA, Cao, S, Capodici, A, Cardenas, R, Carreras, G, Carugno, A, Carvalho, M, Castaldelli-Maia, JM, Castelpietra, G, Cattaruzza, MS, Caye, A, Cegolon, L, Cembranel, F, Cenko, E, Cerin, E, Chadban, SJ, Chadwick, J, Chakraborty, C, Chakraborty, S, Chalek, J, Chan, JSK, Chandika, RM, Chandy, S, Charan, J, Chaudhary, AA, Chaurasia, A, Chen, A-T, Chen, H, Chen, MX, Chen, S, Cherbuin, N, Chi, G, Chichagi, F, Chimed-Ochir, O, Chimoriya, R, Ching, PR, Chirinos-Caceres, JL, Chitheer, A, Cho, DY, Cho, WCS, Choi, D-W, Chong, B, Chong, CL, Chopra, H, Chu, D-T, Chung, E, Chutiyami, M, Clayton, JT, Cogen, RM, Cohen, AJ, Columbus, A, Comfort, H, Conde, J, Connolly, JT, Cooper, EEK, Cortese, S, Cruz-Martins, N, da Silva, AG, Dadras, O, Dai, X, Dai, Z, Dalton, BE, Damiani, G, Dandona, L, Dandona, R, Das, JK, Das, S, Dash, NR, Davletov, K, De la Hoz, FP, De Leo, D, Debopadhaya, S, Delgado-Enciso, I, Denova-Gutierrez, E, Dervenis, N, Desai, HD, Devanbu, VGC, Dewan, SMR, Dhama, K, Dhane, AS, Dhingra, S, da Silva, DD, Diaz, D, Diaz, LA, Diaz, MJ, Dima, A, Ding, DD, Do, THP, Do Prado, CB, Dodangeh, M, Doegah, PT, Dohare, S, Dong, W, D'Oria, M, Doshi, R, Dowou, RK, Dsouza, HL, Dsouza, V, Dube, J, Dumith, SC, Duncan, BB, Duraes, AR, Duraisamy, S, Durojaiye, OC, Dushpanova, A, Dutta, S, Dzianach, PA, Dziedzic, AM, Eboreime, E, Ebrahimi, A, Kalan, ME, Edinur, HA, Efendi, F, Eikemo, TA, Eini, E, Ekundayo, TC, El Arab, RA, El Sayed, I, Elamin, O, Elemam, NM, ElGohary, GMT, Elhadi, M, Elmeligy, OAA, Elmoselhi, AB, Elshaer, M, Elsohaby, I, Eltahir, ME, Emeto, TI, Eshrati, B, Eslami, M, Esmaeili, Z, Fabin, N, Fagbamigbe, AF, Fagbule, OF, Falzone, L, Fareed, M, Farinha, CSES, Faris, MEM, Faro, A, Fasihi, K, Fatehizadeh, A, Fauk, NK, Fazylov, T, Feigin, VL, Fekadu, G, Feng, X, Fereshtehnejad, S-M, Ferrara, P, Ferreira, N, Firew, BS, Fischer, F, Fitriana, I, Flavel, J, Flor, LS, Folayan, MO, Foley, KM, Fonzo, M, Force, LM, Foschi, M, Freitas, A, Fridayani, NKY, Fukutaki, KG, Furtado, JM, Fux, B, Gaal, PA, Gadanya, MA, Gallus, S, Ganesan, B, Ganiyani, MA, Gautam, RK, Gebi, TG, Gebregergis, MW, Gebrehiwot, M, Getacher, L, Getahun, GKA, Gething, PW, Ghadimi, DJ, Ghadirian, F, Ghafarian, S, Ghailan, KY, Ghasemi, M, Dabaghi, GG, Ghazy, RM, Ghoba, S, Gholami, E, Gholamrezanezhad, A, Gholizadeh, N, Ghorbani, M, Vajargah, PG, Ghotbi, E, Gil, AU, Gill, TK, Girmay, A, Glasbey, JC, Glushkova, EV, Gnedovskaya, EV, Gobolos, L, Goldust, M, Goleij, P, Golinelli, D, Gopalani, SV, Goulart, AC, Gouravani, M, Goyal, A, Grivna, M, Grosso, G, Guarducci, G, Gubari, MIM, Guicciardi, S, Guimaraes, RA, Gulati, S, Gulisashvili, D, Gunawardane, DA, Guo, C, Gupta, AK, Gupta, R, Gupta, S, Gupta, VK, Haakenstad, A, Hadi, NR, Haep, N, Hafiz, A, Haghmorad, D, Haile, D, Ali, AH, Ali, HA, Haj-Mirzaian, A, Halboub, ES, Haller, S, Halwani, R, Abdullah, KH, Hamdy, NM, Hamoudi, R, Hanifi, N, Hankey, GJ, Haq, ZA, Haque, MR, Harapan, H, Hargono, A, Haro, JM, Hasaballah, AI, Hasan, SMM, Hasanian, M, Hasnain, MS, Hassan, A, Haubold, J, Hay, SI, Hebert, JJ, Hegazi, OE, Heidari, M, Hemmati, M, Henson, CA, Herrera-Serna, BY, Herteliu, C, Heydari, M, Hezam, K, Hidayana, I, Hiraike, Y, Hoan, NQ, Holla, R, Hoogar, P, Horita, N, Hossain, MM, Hosseinzadeh, H, Hosseinzadeh, M, Hostiuc, M, Hostiuc, S, Hu, C, Huang, J, Hultstrom, M, Hundie, TG, Hunt, AJ, Hushmandi, K, Hussain, J, Hussain, MA, Hussein, NR, Huynh, H-H, Hwang, B-F, Ibitoye, SE, Iftikhar, PM, Ikiroma, AI, Ikwegbue, PC, Ilic, IM, Ilic, MD, Immurana, M, Isa, MA, Islam, MR, Islam, SMS, Ismail, F, Ismail, NE, Isola, G, Iwagami, M, Iyamu, IO, Jacob, L, Jacobsen, KH, Jafarinia, M, Jahankhani, K, Jahanmehr, N, Jain, N, Jairoun, AA, Mani, DRJ, Jamil, S, Jamora, RDG, Jatau, AI, Javadov, S, Javaheri, T, Jayaram, S, Jee, SH, Jeganathan, J, Jiang, H, Jokar, M, Jonas, JB, Joseph, N, Joshua, CE, Jurisson, M, Vaishali, K, Kabir, A, Kabir, Z, Kadashetti, V, Kalankesh, LR, Kalra, S, Kamath, A, Kamath, R, Kamireddy, A, Kanaan, M, Kanchan, T, Kanmiki, EW, Kanmodi, KK, Kansal, SK, Karim, A, Karkhah, S, Kashoo, FZ, Kasraei, H, Kassel, MB, Katikireddi, SV, Kauppila, JH, Kaur, H, Kayode, GA, Kazemi, F, Kazemian, S, Kebede, F, Kendal, ES, Kesse-Guyot, E, Khademvatan, S, Khajuria, H, Khalaji, A, Khalid, A, Khalid, N, Khalilian, A, Khamesipour, F, Khan, F, Khan, MJ, Khan, MAB, Khanmohammadi, S, Khatab, K, Khatatbeh, H, Khatatbeh, MM, Khatib, MN, Kashani, HRK, Kheirallah, KA, Khokhar, M, Khormali, M, Khorrami, Z, Khosla, AA, Khosravi, M, Khosrowjerdi, M, Khubchandani, J, Kifle, ZD, Kim, G, Kim, JS, Kim, MS, Kim, YJ, Kimokoti, RW, Kisa, A, Kisa, S, Knibbs, LD, Knudsen, AKS, Kochhar, S, Kolahi, A-A, Kompani, F, Koren, G, Korzh, O, Krishan, K, Krishna, V, Krishnamoorthy, V, Bicer, BK, Kuddus, MA, Kuddus, M, Kuitunen, I, Kujan, O, Kulimbet, M, Kulkarni, V, Kumar, GA, Kumar, H, Kumar, N, Kumar, R, Kumar, V, Kundu, A, Kusuma, D, Kyei-Arthur, F, Kyto, V, Kyu, HH, La Vecchia, C, Lacey, B, Ladan, MA, Laflamme, L, Lahariya, C, Lai, DTC, Lalloo, R, Lallukka, T, Lam, J, Lan, Q, Lan, T, Landires, I, Lanfranchi, F, Langguth, B, Lansingh, VC, Laplante-Levesque, A, Larijani, B, Larsson, AO, Lasrado, S, Lauriola, P, Lawlor, HR, Le, H-H, Le, LKD, Le, NHH, Le, TTT, Le, TDT, Leasher, JL, Lee, DW, Lee, M, Lee, PH, Lee, S-W, Lee, SW, Lee, SWH, Lee, YH, Leigh, J, Leong, E, Li, M-C, Libra, M, Ligade, VS, Lim, L-L, Lim, SS, Limenh, LW, Lindholm, D, Lindstedt, PA, Listl, S, Liu, G, Liu, S, Liu, X, Llanaj, E, Lopez-Bueno, R, Lopez-Gil, JF, Loreche, AM, Lotufo, PA, Lozano, R, Lubinda, J, Lucchetti, G, Luo, L, Lusk, JB, Lv, L, Amin, HIM, Ma, ZF, Maass, KL, Machairas, N, Machoy, M, Madureira-Carvalho, AM, Abd El Razek, HM, Maghazachi, AA, Prasad, DRM, Mahalleh, M, Mahasha, PW, Mahmoud, MA, Mahmoudi, E, Mahmoudvand, G, Makama, M, Rad, EM, Malhotra, K, Malik, AA, Malta, DC, Manla, Y, Mansour, A, Mansouri, MH, Mansouri, P, Mansouri, V, Mansourian, M, Mansournia, MA, Marasini, BP, Marateb, HR, Maravilla, JC, Mardi, P, Marjani, A, Moghadam, HM, Arnedo, CAM, Martinez, G, Martinez-Piedra, R, Martins-Melo, FR, Martorell, M, Marx, W, Marzo, RR, Masoudi, S, Mathangasinghe, Y, Mathioudakis, AG, Mathur, M, Mathur, N, Matozinhos, FP, Mattumpuram, J, Maude, RJ, Maugeri, A, Mayeli, M, Mazidi, M, Mazzotti, A, McGrath, JJ, Mckee, M, McKowen, ALW, McPhail, MA, McPhail, SM, Mehmood, A, Mehrabani-Zeinabad, K, Mehravar, S, Meto, TM, Melese, EB, Mendez-Lopez, MAM, Mendoza, W, Menezes, RG, Mensah, GA, Mensah, LG, Mentis, A-FA, Meo, SA, Meretoja, A, Meretoja, TJ, Mersha, AM, Mestrovic, T, Mettananda, KCD, Mettananda, S, Mhlanga, A, Mhlanga, L, Miazgowski, T, Michalek, IM, de Sa, ACMGN, Miller, TR, Minh, LHN, Mirahmadi, A, Mirijello, A, Mirrakhimov, EM, Mirzaei, R, Mitchell, PB, Mittal, C, Moberg, ME, Fard, AM, Mohajelin, S, Mohamadkhani, A, Mohamed, AI, Mohamed, J, Mohamed, MFH, Mohamed, NS, Mohammad, AM, Mohammadi, S, Mohammed, H, Mohammed, M, Mohammed, S, Mokdad, AH, Molokhia, M, Momani, SM, Momtazmanesh, S, Monasta, L, Mondello, S, Moni, MA, Montazeri, F, Ghalibaf, AM, Moradi, M, Moradi, Y, Moraga, P, Morawska, L, Moreira, RS, Morovatdar, N, Morrison, SD, Mosapour, A, Mosser, JF, Mossialos, E, Motappa, R, Mougin, V, Mousavi, P, Mrejen, M, Mubarik, S, Mueller, UO, Mulita, F, Munjal, K, Murillo-Zamora, E, Musallam, KM, Musina, A-M, Mustafa, G, Myung, W, Nafei, A, Nagarajan, AJ, Naghavi, P, Naik, GR, Naik, G, Nainu, F, Najdaghi, S, Ansari, NN, Nangia, V, Swamy, SN, Nargus, S, Davani, DN, Nascimento, BR, Nascimento, GG, Naser, AY, Nashwan, AJ, Natto, ZS, Nauman, J, Navaratna, SNK, Naveed, M, Nawsherwan, Nayak, BP, Nayak, VC, Negash, H, Negoi, I, Negoi, RI, Nejadghaderi, SA, Nejjari, C, Nematollahi, S, Netsere, HB, Ng, M, Nguefack-Tsague, G, Ngunjiri, JW, Nguyen, AH, Nguyen, DH, Nguyen, HTH, Nguyen, N, Nguyen, NNY, Nguyen, PT, Nguyen, QP, Nguyen, VT, Minh, DNT, Niazi, RK, Nigatu, YT, Niknam, M, Nikoobar, A, Nikpoor, AR, Nikravangolsefid, N, Noman, EA, Nomura, S, Noor, STA, Noroozi, N, Nouri, M, Nozari, M, Nri-Ezedi, CA, Ntaios, G, Nunemo, MH, Nurrika, D, Nutor, JJ, Nzoputam, CI, Nzoputam, OJ, Oancea, B, Obamiro, KO, Odetokun, IA, Oduro, MS, Ogundijo, OA, Ogunfowokan, AA, Ogunkoya, A, Oguntade, AS, Oh, I-H, Ojo-Akosile, TR, Okati-Aliabad, H, Okekunle, AP, Okonji, OC, Olagunju, AT, Olatubi, MI, Oliveira, GMM, Olusanya, BO, Olusanya, JO, Oluwafemi, YD, Omar, HA, Omer, GL, Ong, S, Onie, S, Onwujekwe, OE, Opejin, AO, Ordak, M, Orish, VN, Ortiz, A, Ortiz-Prado, E, Osman, WMS, Ostojic, SM, Ostroff, SM, Osuagwu, UL, Otoiu, A, Otstavnov, SS, Ouyahia, A, Owolabi, MO, Oyeyemi, OT, Ozair, A, Padukudru, MPA, Padron-Monedero, A, Padubidri, JR, Pal, PK, Palicz, T, Pan, F, Pan, H-F, Panda-Jonas, S, Pandey, A, Pando-Robles, V, Pangaribuan, HU, Panos, GD, Panos, LD, Pantazopoulos, I, Stoian, AMP, Parikh, RR, Park, E-K, Park, S, Parsons, N, Parthasarathi, A, Pasovic, M, Passera, R, Patel, J, Pathan, AR, Patil, S, Patoulias, D, Pawar, S, Toroudi, HP, Pease, SA, Peden, AE, Pedersini, P, Pensato, U, Pepito, VCF, Peprah, P, Pereira, M, Pereira, MO, Perianayagam, A, Perico, N, Perna, S, Pesudovs, K, Petermann-Rocha, FE, Pham, HT, Philip, AK, Phillips, MR, Pigeolet, M, Piradov, MA, Pisoni, E, Plotnikov, E, Poddighe, D, Polibin, RV, Poluru, R, Ponkilainen, VT, Popovic, DS, Postma, MJ, Pour-Rashidi, A, Prabhu, D, Prada, SI, Pradhan, J, Pradhan, PMS, Prashant, A, Prates, EJS, Priscilla, T, Purnobasuki, H, Purohit, BM, Puvvula, J, Qasim, NH, Qattea, I, Qazi, AS, Qian, G, Rad, MR, Radhakrishnan, V, Shahraki, HR, Rafferty, Q, Raggi, A, Raggi, C, Raheem, N, Rahim, F, Rahim, MJ, Rahimibarghani, S, Rahman, MMMR, Rahman, M, Rahman, MA, Rahman, T, Rahmani, AM, Rahmanian, M, Rahmanian, N, Rahmati, R, Rahmawaty, S, Raimondo, D, Raja, A, Rajput, P, Ramadan, M, Ramasamy, SK, Ramazanu, 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Watson, S, Weaver, MR, Weerakoon, KG, Weintraub, RG, Weldetinsaa, HLL, Wells, KM, Wen, YF, Westerman, R, Wiangkham, T, Wickramasinghe, DP, Widowati, E, Wojewodzic, MW, Woldeyes, DH, Wolf, AW, Wolfe, CDA, Wu, C, Wu, D, Wu, F, Wu, J, Wu, Z, Hanson, SW, Xiao, H, Xu, S, Yadav, R, Yamagishi, K, Yang, D, Yano, Y, Yarahmadi, A, Nia, IY, Ye, P, Yesodharan, R, Yesuf, SA, Yezli, S, Yigit, A, Yigit, V, Yigzaw, ZA, Yin, D, Yip, P, Yonemoto, N, You, Y, Younis, MZ, Yu, C, Yu, EA, Yu, Y, Yuan, C-W, Yusuf, H, Zafar, U, Zafari, N, Zahid, MH, Zakham, F, Zaki, N, Zerfu, TA, Zhang, H, Zhang, J, Zhang, L, Zhang, Y, Zhang, Z, Zhao, X-JG, Zhao, Y, Zhao, Z, Zhong, C, Zhou, B, Zhou, J, Zhou, S, Zhu, B, Zhumagaliuly, A, Zielinska, M, Zoghi, G, Zumla, A, Zyoud, SH, Smith, AE, and Murray, CJL
Abstract: BACKGROUND: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. METHODS: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects m
Published: 2024

4. Are Outcomes From an Exercise Therapy and Patient Education Program for Osteoarthritis Associated With Hip and Knee Replacement Within Two Years? A Register-Based Study of 9,339 Patients With Osteoarthritis.

Author: Ackerman, IN, Johansson, MS, Grønne, DT, Clausen, S, Ernst, MT, Overgaard, S, Odgaard, A, Roos, EM, Skou, ST, Ackerman, IN, Johansson, MS, Grønne, DT, Clausen, S, Ernst, MT, Overgaard, S, Odgaard, A, Roos, EM, and Skou, ST
Abstract: OBJECTIVE: The objective of this study was to determine whether short-term outcomes from exercise therapy and patient education for osteoarthritis (OA) are associated with hip or knee replacement within two years. METHODS: Individual-level data from the Good Life with osteoArthritis in Denmark (GLA:D) Registry were linked to the Danish National Patient Registry and other national registries. Cox proportional hazards models were used to investigate associations between program outcomes (baseline to three-month changes) and time to primary hip or knee replacement. Patients who did not receive joint replacement were censored at two years, time of death, or emigration. RESULTS: A total of 2,304 and 7,035 patients with clinically diagnosed hip and knee OA, respectively, were included. Of these, 30% with hip OA and 10% with knee OA had joint replacement within two years. Postprogram improvements in hip-related quality of life and arthritis self-efficacy (pain subscale) were associated with a reduced hazard of hip replacement (adjusted hazard ratios [HRs] for a 10-unit improvement: 0.74 [95% confidence interval (CI) 0.69-0.80] and 0.90 [95% CI 0.85-0.96], respectively). Improvements in knee pain, knee-related quality of life, and arthritis self-efficacy (pain subscale) were associated with a lower hazard of knee replacement (adjusted HRs for 10-unit improvement: 0.81 [95% CI 0.76-0.86] to 0.90 [95% CI 0.86-0.95], 0.70 [95% CI 0.63-0.78] to 0.79 [95% CI 0.72-0.86], and 0.89 [95% CI 0.83-0.94], respectively). CONCLUSION: The magnitude of improvement in key measures after exercise therapy and education was significantly associated with the likelihood of surgery. Progression to hip replacement was three times higher than progression to knee replacement. This information can guide patient-clinician conversations around anticipated program outcomes.
Published: 2024

5. Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Author: Brauer, M, Roth, GA, Aravkin, AY, Zheng, P, Abate, KH, Abate, YH, Abbafati, C, Abbasgholizadeh, R, Abbasi, MA, Abbasian, M, Abbasifard, M, Moradi, Y, Bensenor, IM, Benzian, H, Beran, A, Abouzid, M, Berezvai, Z, Bernabe, E, Bernstein, RS, Bettencourt, PJG, Bhagavathula, AS, Bhala, N, Moraga, P, Bhandari, D, Bhardwaj, N, Bhardwaj, P, Bhaskar, S, Aboye, GB, Bhat, AN, Bhat, V, Bhatti, GK, Bhatti, JS, Bhatti, MS, Morawska, L, Bhatti, R, Bhuiyan, MA, Bhutta, ZA, Bikbov, B, Bishai, JD, Abreu, LG, Bisignano, C, Biswas, A, Biswas, B, Biswas, RK, Moreira, RS, Bjørge, T, Boachie, MK, Boakye, H, Bockarie, MJ, Bodolica, V, Bodunrin, AO, Abualruz, H, Bogale, EK, Bolla, SR, Boloor, A, Morovatdar, N, Bonakdar Hashemi, M, Boppana, SH, Bora Basara, B, Borhany, H, Botero Carvajal, A, Bouaoud, S, Boufous, S, Abubakar, B, Bourne, R, Boxe, C, Morrison, SD, Braithwaite, D, Brant, LC, Brar, A, Breitborde, NJK, Breitner, S, Brenner, H, Briko, AN, Britton, G, Abu-Gharbieh, E, Brown, CS, Morze, J, Browne, AJ, Brunoni, AR, Bryazka, D, Bulamu, NB, Bulto, LN, Buonsenso, D, Burkart, K, Burns, RA, Busse, R, Abukhadijah, HJJ, Mosaddeghi Heris, R, Bustanji, Y, Butt, NS, Butt, ZA, Caetano dos Santos, FL, Cagney, J, Cahuana-Hurtado, L, Calina, D, Cámera, LA, Campos, LA, Campos-Nonato, IR, Mossialos, E, Aburuz, S, Cao, C, Cao, F, Cao, Y, Capodici, A, Cárdenas, R, Carr, S, Carreras, G, Carrero, JJ, Carugno, A, Motappa, R, Carvalho, F, Abu-Zaid, A, Carvalho, M, Castaldelli-Maia, JM, Castañeda-Orjuela, CA, Castelpietra, G, Catalá-López, F, Catapano, AL, Cattaruzza, MS, Caye, A, Alemayohu, MA, Ali, BA, Cederroth, CR, Cegolon, L, Adane, MM, Cenderadewi, M, Cercy, KM, Cerin, E, Chadwick, J, Chakraborty, C, Chakraborty, PA, Chakraborty, S, Mougin, V, Chan, JSK, Chan, RNC, Chandan, JS, Addo, IY, Chandika, RM, Chaturvedi, P, Chen, A-T, Chen, CS, Chen, H, Chen, MX, Mousavi, P, Chen, M, Chen, S, Cheng, C-Y, Cheng, ETW, Addolorato, G, Cherbuin, N, Chi, G, Chichagi, F, Chimed-Ochir, O, Chimoriya, 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W, Murillo-Zamora, E, Dhimal, M, Adibi, A, Dhingra, S, Dhulipala, VR, Dhungana, RR, Dias da Silva, D, Diaz, D, Diaz, LA, Diaz, MJ, Dima, A, Abbasi-Kangevari, M, Ding, DD, Dinu, M, Adnani, QES, Djalalinia, S, Do, TC, Do, THP, do Prado, CB, Dodangeh, M, Dohare, S, Dokova, KG, Ali, I, Dong, W, Dongarwar, D, D'Oria, M, Adzigbli, LA, Dorostkar, F, Dorsey, ER, Doshi, R, Doshmangir, L, Dowou, RK, Driscoll, TR, Murlimanju, BV, Dsouza, AC, Dsouza, HL, Dumith, SC, Duncan, BB, Afolabi, AA, Duraes, AR, Duraisamy, S, Dushpanova, A, Dzianach, PA, Dziedzic, AM, Musina, A-M, Ebrahimi, A, Echieh, CP, Ed-Dra, A, Edinur, HA, Edvardsson, D, Afolabi, RF, Edvardsson, K, Efendi, F, Eftekharimehrabad, A, Eini, E, Mustafa, G, Ekholuenetale, M, Ekundayo, TC, El Arab, RA, El Sayed Zaki, M, El-Dahiyat, F, Elemam, NM, Afshin, A, Elgar, FJ, ElGohary, GMT, Elhabashy, HR, Muthu, S, Elhadi, M, Elmehrath, AO, Elmeligy, OAA, Elshaer, M, Elsohaby, I, Emeto, TI, Esfandiari, N, Afyouni, S, Eshrati, B, Eslami, M, 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GS, Azizi, H, Abegaz, TM, Azzam, AY, Backhaus, IL, Mondello, S, Badar, M, Badiye, AD, Bagga, A, Baghdadi, S, Bagheri, N, Bagherieh, S, Bahrami Taghanaki, P, Bai, R, Abeldaño Zuñiga, RA, Baig, AA, Moni, MA, Baker, JL, Bakkannavar, SM, Balasubramanian, M, Baltatu, OC, Bam, K, Bandyopadhyay, S, Banik, B, Banik, PC, Banke-Thomas, A, Abiodun, O, Moodi Ghalibaf, A, Bansal, H, Barchitta, M, Bardhan, M, Bardideh, E, Barker-Collo, SL, Bärnighausen, TW, Barone-Adesi, F, Barqawi, HJ, Barrero, LH, Barrow, A, Moore, CE, Abiso, TL, Barteit, S, Basharat, Z, Basiru, A, Basso, JD, Bastan, M-M, Basu, S, Batchu, S, Batra, K, Batra, R, Moradi, M, Baune, BT, Aboagye, RG, Bayati, M, Bayileyegn, NS, Beaney, T, Behnoush, AH, Beiranvand, M, Béjot, Y, Bekele, A, Belgaumi, UI, Bell, AW, Bell, ML, Abolhassani, H, Bello, MB, Bello, OO, Belo, L, Beloukas, A, Bendak, S, Bennett, DA, and Bennitt, FB
Published: 2024

6. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Author: Ferrari, AJ, Santomauro, DF, Aali, A, Abate, YH, Abbafati, C, Abbastabar, H, Abd ElHafeez, S, Abdelmasseh, M, Abd-Elsalam, S, Abdollahi, A, Abdullahi, A, Abegaz, KH, Abeldaño Zuñiga, RA, Aboagye, RG, Abolhassani, H, Abreu, LG, Abualruz, H, Abu-Gharbieh, E, Abu-Rmeileh, NME, Ackerman, IN, Addo, IY, Addolorato, G, Adebiyi, AO, Adepoju, AV, Adewuyi, HO, Afyouni, S, Afzal, S, Agodi, A, Ahmad, A, Ahmad, D, Ahmad, F, Ahmad, S, Ahmed, A, Ahmed, LA, Ahmed, MB, Ajami, M, Akinosoglou, K, Akkaif, MA, Al Hasan, SM, Alalalmeh, SO, Al-Aly, Z, Albashtawy, M, Aldridge, RW, Alemu, MD, Alemu, YM, Alene, KA, Al-Gheethi, AAS, Alharrasi, M, Alhassan, RK, Ali, MU, Ali, R, Ali, SSS, Alif, SM, Aljunid, SM, Al-Marwani, S, Almazan, JU, Alomari, MA, Al-Omari, B, Altaany, Z, Alvis-Guzman, N, Alvis-Zakzuk, NJ, Alwafi, H, Al-Wardat, MS, Al-Worafi, YM, Aly, S, Alzoubi, KH, Amare, AT, Amegbor, PM, Ameyaw, EK, Amin, TT, Amindarolzarbi, A, Amiri, S, Amugsi, DA, Ancuceanu, R, Anderlini, D, Anderson, DB, Andrade, PP, Andrei, CL, Ansari, H, Antony, CM, Anwar, S, Anwar, SL, Anwer, R, Anyanwu, PE, Arab, JP, Arabloo, J, Arafat, M, Araki, DT, Aravkin, AY, Arkew, M, Armocida, B, Arndt, MB, Arooj, M, Artamonov, AA, Aruleba, RT, Arumugam, A, Ashbaugh, C, Ashemo, MY, Ashraf, M, Asika, MO, Askari, E, Astell-Burt, T, Athari, SS, Atorkey, P, Atout, MMW, Atreya, A, Aujayeb, A, Ausloos, M, Avan, A, Awotidebe, AW, Awuviry-Newton, K, Ayala Quintanilla, BP, Ayuso-Mateos, JL, Azadnajafabad, S, Azevedo, RMS, Babu, AS, Badar, M, Badiye, AD, Baghdadi, S, Bagheri, N, Bah, S, Bai, R, Baker, JL, Bakkannavar, SM, Bako, AT, Balakrishnan, S, Bam, K, Banik, PC, Barchitta, M, Bardhan, M, Bardideh, E, Barker-Collo, SL, Barqawi, HJ, Barrow, A, Barteit, S, Barua, L, Bashiri Aliabadi, S, Basiru, A, Basu, S, Bathini, PP, Batra, K, Baune, BT, Bayileyegn, NS, Behnam, B, Behnoush, AH, Beiranvand, M, Bejarano Ramirez, DF, Bell, ML, Bello, OO, Beloukas, A, Bensenor, IM, Berezvai, Z, Bernabe, E, Bernstein, RS, Bettencourt, PJG, Bhagavathula, AS, Bhala, N, Bhandari, D, Bhargava, A, Bhaskar, S, Bhat, V, Bhatti, GK, Bhatti, JS, Bhatti, MS, Bhatti, R, Bhutta, ZA, Bikbov, B, Bishai, JD, Bisignano, C, Bitra, VR, Bjørge, T, Bodolica, V, Bodunrin, AO, Bogale, EK, Bonakdar Hashemi, M, Bonny, A, Bora Basara, B, Borhany, H, Boxe, C, Brady, OJ, Bragazzi, NL, Braithwaite, D, Brant, LC, Brauer, M, Breitner, S, Brenner, H, Brown, J, Brugha, T, Bulamu, NB, Buonsenso, D, Burkart, K, Burns, RA, Busse, R, Bustanji, Y, Butt, ZA, Byun, J, Caetano dos Santos, FL, Calina, D, Cámera, LA, Campos-Nonato, IR, Cao, C, Capodici, A, Carr, S, Carreras, G, Carugno, A, Carvalho, M, Castaldelli-Maia, JM, Castañeda-Orjuela, CA, Castelpietra, G, Catapano, AL, Cattaruzza, MS, Caye, A, Cegolon, L, Cembranel, F, Cenderadewi, M, Cerin, E, Chakraborty, PA, Chan, JSK, Chan, RNC, Chandika, RM, Chandrasekar, EK, Charalampous, P, Chattu, VK, Chatzimavridou-Grigoriadou, V, Chen, AW, Chen, A-T, Chen, CS, Chen, H, Chen, NM, Cheng, ETW, Chimed-Ochir, O, Chimoriya, R, Ching, PR, Cho, WCS, Choi, S, Chong, B, Chong, YY, Choudhari, SG, Chowdhury, R, Christensen, SWM, Chu, D-T, Chukwu, IS, Chung, E, Chutiyami, M, Claassens, MM, Cogen, RM, Columbus, A, Conde, J, Cortesi, PA, Cousin, E, Criqui, MH, Cruz-Martins, N, Dadras, O, Dai, S, Dai, X, Dai, Z, Dalaba, MA, Damiani, G, Das, JK, Das, S, Dashti, M, Dávila-Cervantes, CA, Davletov, K, De Leo, D, Debele, AT, Debopadhaya, S, DeCleene, NK, Deeba, F, Degenhardt, L, Del Bo', C, Delgado-Enciso, I, Demetriades, AK, Denova-Gutiérrez, E, Dervenis, N, Desai, HD, Desai, R, Deuba, K, Dhama, K, Dharmaratne, SD, Dhingra, S, Dias da Silva, D, Diaz, D, Diaz, LA, Diaz, MJ, Dima, A, Ding, DD, Dirac, MA, Do, THP, do Prado, CB, Dohare, S, Dominguez, R-MV, Dong, W, Dongarwar, D, D'Oria, M, Dorsey, ER, Doshmangir, L, Dowou, RK, Driscoll, TR, Dsouza, HL, Dsouza, V, Dube, J, Dumith, SC, Duncan, BB, Duraes, AR, Duraisamy, S, Durojaiye, OC, Dzianach, PA, Dziedzic, AM, Eboreime, E, Ebrahimi, A, Edinur, HA, 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Pease, SA, Peden, AE, Pedersini, P, Peng, M, Pensato, U, Pepito, VCF, Peprah, EK, Peprah, P, Perdigão, J, Pereira, MO, Perianayagam, A, Perico, N, Pesudovs, K, Petermann-Rocha, FE, Petri, WA, Pham, HT, Philip, AK, Phillips, MR, Pigeolet, M, Pigott, DM, Pillay, JD, Piracha, ZZ, Pirouzpanah, S, Plass, D, Plotnikov, E, Poddighe, D, Polinder, S, Postma, MJ, Pourtaheri, N, Prada, SI, Pradhan, PMS, Prakash, V, Prasad, M, Prates, EJS, Priscilla, T, Pritchett, N, Puri, P, Puvvula, J, Qasim, NH, Qattea, I, Qazi, AS, Qian, G, Rabiee Rad, M, Radhakrishnan, RA, Radhakrishnan, V, Raeisi Shahraki, H, Rafferty, Q, Raggi, A, Raghav, PR, Rahim, MJ, Rahman, MM, Rahman, MHU, Rahman, M, Rahman, MA, Rahmani, S, Rahmanian, M, Rahmawaty, S, Rajaa, S, Ramadan, MM, Ramasamy, SK, Ramasubramani, P, Ramazanu, S, Rana, K, Ranabhat, CL, Rancic, N, Rane, A, Rao, CR, Rao, K, Rao, M, Rao, SJ, Rashidi, M-M, Rathnaiah Babu, G, Rauniyar, SK, Rawaf, DL, Rawaf, S, Razo, C, Reddy, MMRK, Redwan, EMM, Reifels, L, Reiner Jr, RC, Remuzzi, G, Renzaho, AMN, Reshmi, B, Reyes, LF, Rezaei, N, Rezaei Hachesu, P, Rezaeian, M, Rickard, J, Rodrigues, CF, Rodriguez, JAB, Roever, L, Ronfani, L, Roshandel, G, Rotimi, K, Rout, HS, Roy, B, Roy, N, Roy, P, Rubagotti, E, S N, C, Saad, AMA, Saber-Ayad, MM, Sabour, S, Sacco, S, Sachdev, PS, Saddik, B, Saddler, A, Sadee, BA, Sadeghi, E, Sadeghi, M, Saeb, MR, Saeed, U, Safi, SZ, Sagar, R, Sagoe, D, Saif, Z, Sajid, MR, Sakshaug, JW, Salam, N, Salami, AA, Salaroli, LB, Saleh, MA, Salem, MR, Salem, MZY, Sallam, M, Samadzadeh, S, Samargandy, S, Samodra, YL, Samy, AM, Sanabria, J, Sanna, F, Santos, IS, Santric-Milicevic, MM, Sarasmita, MA, Sarikhani, Y, Sarmiento-Suárez, R, Sarode, GS, Sarode, SC, Sarveazad, A, Sathian, B, Sathyanarayan, A, Satpathy, M, Sawhney, M, Scarmeas, N, Schaarschmidt, BM, Schmidt, MI, Schneider, IJC, Schumacher, AE, Schwebel, DC, Schwendicke, F, Sedighi, M, Senapati, S, Senthilkumaran, S, Sepanlou, SG, Sethi, Y, Setoguchi, S, Seylani, A, Shadid, J, Shafie, M, Shah, H, Shah, NS, Shah, PA, Shahbandi, A, Shahid, S, Shahid, W, Shahwan, MJ, Shaikh, MA, Shakeri, A, Shalash, AS, Sham, S, Shamim, MA, Shamshirgaran, MA, Shamsi, MA, Shanawaz, M, Shankar, A, Shannawaz, M, Sharath, M, Sharifan, A, Sharifi-Rad, J, Sharma, M, Sharma, R, Sharma, S, Sharma, U, Sharma, V, Shastry, RP, Shavandi, A, Shayan, AM, Shayan, M, Shehabeldine, AME, Shetty, PH, Shibuya, K, Shifa, JE, Shiferaw, D, Shiferaw, WS, Shigematsu, M, Shiri, R, Shitaye, NA, Shittu, A, Shivakumar, KM, Shivarov, V, Shokati Eshkiki, Z, Shool, S, Shrestha, S, Shuval, K, Sibhat, MM, Siddig, EE, Sigfusdottir, ID, Silva, DAS, Silva, JP, Silva, LMLR, Silva, S, Simpson, CR, Singal, A, Singh, A, Singh, BB, Singh, H, Singh, JA, Singh, M, Singh, P, Skou, ST, Sleet, DA, Slepak, ELN, Solanki, R, Soliman, SSM, Song, S, Song, Y, Sorensen, RJD, Soriano, JB, Soyiri, IN, Spartalis, M, Sreeramareddy, CT, Stark, BA, Starodubova, AV, Stein, C, Stein, DJ, Steiner, C, Steiner, TJ, Steinmetz, JD, Steiropoulos, P, Stockfelt, L, Stokes, MA, Subedi, NS, Subramaniyan, V, Suemoto, CK, Suleman, M, Suliankatchi Abdulkader, R, Sultana, A, Sundström, J, Swain, CK, Szarpak, L, Tabaee Damavandi, P, Tabarés-Seisdedos, R, Tabatabaei Malazy, O, Tabatabaeizadeh, S-A, Tabatabai, S, Tabche, C, Tabish, M, Tadakamadla, SK, Taheri Abkenar, Y, Taheri Soodejani, M, Taherkhani, A, Taiba, J, Talaat, IM, Talukder, A, Tampa, M, Tamuzi, JL, Tan, K-K, Tandukar, S, Tang, H, Tavakoli Oliaee, R, Tavangar, SM, Teimoori, M, Temsah, M-H, Teramoto, M, Thangaraju, P, Thankappan, KR, Thapar, R, Thayakaran, R, Thirunavukkarasu, S, Thomas, N, Thomas, NK, Thum, CCC, Tichopad, A, Ticoalu, JHV, Tillawi, T, Tiruye, TY, Tobe-Gai, R, Tonelli, M, Topor-Madry, R, Torre, AE, Touvier, M, Tovani-Palone, MR, Tran, JT, Tran, MTN, Tran, NM, Tran, N-H, Trico, D, Tromans, SJ, Truyen, TTTT, Tsatsakis, A, Tsegay, GM, Tsermpini, EE, Tumurkhuu, M, Tyrovolas, S, Udoh, A, Umair, M, Umakanthan, S, Umar, TP, Undurraga, EA, Unim, B, Unnikrishnan, B, Unsworth, CA, Upadhyay, E, Urso, D, Usman, JS, Vahabi, SM, Vaithinathan, AG, Van den Eynde, J, Varga, O, Varma, RP, Vart, P, Vasankari, TJ, Vasic, M, Vaziri, S, Vellingiri, B, Venketasubramanian, N, Veroux, M, Verras, G-I, Vervoort, D, Villafañe, JH, Violante, FS, Vlassov, V, Vollset, SE, Volovat, SR, Vongpradith, A, Waheed, Y, Wang, C, Wang, F, Wang, N, Wang, S, Wang, Y, Wang, Y-P, Ward, P, Wassie, EG, Weaver, MR, Weerakoon, KG, Weintraub, RG, Weiss, DJ, Weldemariam, AH, Wells, KM, Wen, YF, Whisnant, JL, Whiteford, HA, Wiangkham, T, Wickramasinghe, DP, Wickramasinghe, ND, Wilandika, A, Wilkerson, C, Willeit, P, Wimo, A, Woldegebreal, DH, Wolf, AW, Wong, YJ, Woolf, AD, Wu, C, Wu, F, Wu, X, Wu, Z, Wulf Hanson, S, Xia, Y, Xiao, H, Xu, X, Xu, YY, Yadav, L, Yadollahpour, A, Yaghoubi, S, Yamagishi, K, Yang, L, Yano, Y, Yao, Y, Yaribeygi, H, Yazdanpanah, MH, Ye, P, Yehualashet, SS, Yesuf, SA, Yezli, S, Yiğit, A, Yiğit, V, Yigzaw, ZA, Yismaw, Y, Yon, DK, Yonemoto, N, Younis, MZ, Yu, C, Yu, Y, Yusuf, H, Zahid, MH, Zakham, F, Zaki, L, Zaki, N, Zaman, BA, Zamora, N, Zand, R, Zandieh, GGZ, Zar, HJ, Zarrintan, A, Zastrozhin, MS, Zhang, H, Zhang, N, Zhang, Y, Zhao, H, Zhong, C, Zhong, P, Zhou, J, Zhu, Z, Ziafati, M, Zielińska, M, Zimsen, SRM, Zoladl, M, Zumla, A, Zyoud, SH, Vos, T, and Murray, CJL
Published: 2024

7. Muscle strength, physical performance and physical activity as predictors of future knee replacement: a prospective cohort study

Author: Skou, ST, Wise, BL, Lewis, CE, Felson, D, Nevitt, M, Segal, NA, and Multicenter, Osteoarthritis Study G
Subjects: Osteoarthritis, Knee, Prognosis, Arthroplasty, Replacement, Muscle strength, Motor activity, Arthroplasty, Replacement, Arthritis & Rheumatology, Clinical Sciences, Biomedical Engineering
Published: 2016

8. Muscle strength, physical performance and physical activity as predictors of future total knee arthroplasty: A Prospective Cohort Study

Author: Skou, ST, Wise, BL, Lewis, CE, Felson, D, Nevitt, M, and Segal, NA
Subjects: Biomedical Engineering, Clinical Sciences, Human Movement and Sports Sciences, Arthritis & Rheumatology, Clinical sciences, Sports science and exercise
Published: 2015

9. What should a toolkit to aid the delivery of therapeutic exercise for hip and knee osteoarthritis look like? Qualitative analysis of an international survey of 318 researchers, clinicians, and consumers by the OARSI Rehabilitation Discussion Group

Author: Lawford, BJ, Master, H, Larsen, JB, Bartholdy, C, Corrigan, P, Ginnerup-Nielsen, E, Le, C, Teoli, A, Bennell, KL, Metcalf, B, Hinman, RS, Button, K, Collins, NJ, Cottrell, E, Henrotin, Y, Skou, ST, Thoma, LM, Wellsandt, E, White, DK, Holden, MA, Lawford, BJ, Master, H, Larsen, JB, Bartholdy, C, Corrigan, P, Ginnerup-Nielsen, E, Le, C, Teoli, A, Bennell, KL, Metcalf, B, Hinman, RS, Button, K, Collins, NJ, Cottrell, E, Henrotin, Y, Skou, ST, Thoma, LM, Wellsandt, E, White, DK, and Holden, MA
Abstract: BACKGROUND: We aimed to identify important components of, and practical resources relevant for inclusion in, a toolkit to aid exercise delivery for people with hip/knee osteoarthritis. METHOD: An online international multi-disciplinary survey was conducted across 43 countries (139 clinicians, 44 people with hip/knee osteoarthritis and 135 osteoarthritis researchers). Participants were presented with the seeding statement 'Practical resources to aid the implementation of exercise for people with hip/knee osteoarthritis should…' and asked to provide up to 10 open text responses. Responses underwent refinement and qualitative content analysis to create domains and categories. RESULTS: Refinement of 551 open text responses yielded 72 unique statements relevant for analysis. Statements were organised into nine broad domains, suggesting that resources to aid exercise delivery should: (1) be easily accessible; (2) be of high quality; (3) be developed by, and for, stakeholders; (4) include different ways of delivering information; (5) include different types of resources to support exercise and non-exercise components of self-management; (6) include resources on recommended exercises and how to perform/progress them; (7) include tools to support motivation and track progress; (8) include resources to enable tailoring of the programme to the individual and; (9) facilitate access to professional and peer support. CONCLUSION: Our findings identified important components of, and practical resources to include within, a toolkit to aid delivery of exercise for people with hip/knee osteoarthritis. These findings have implications for exercise providers and lay the foundation for the development of a toolkit to help ensure exercise provision aligns with current international recommendations.
Published: 2023

10. Evaluating Osteoarthritis Management Programs: outcome domain recommendations from the OARSI Joint Effort Initiative

Author: Allen, KD, Huffman, K, Cleveland, RJ, van der Esch, M, Abbott, JH, Abbott, A, Bennell, K, Bowden, JL, Eyles, J, Healey, EL, Holden, MA, Jayakumar, P, Koenig, K, Lo, G, Losina, E, Miller, K, Osteras, N, Pratt, C, Quicke, JG, Sharma, S, Skou, ST, Tveter, AT, Woolf, A, Yu, SP, Hinman, RS, Allen, KD, Huffman, K, Cleveland, RJ, van der Esch, M, Abbott, JH, Abbott, A, Bennell, K, Bowden, JL, Eyles, J, Healey, EL, Holden, MA, Jayakumar, P, Koenig, K, Lo, G, Losina, E, Miller, K, Osteras, N, Pratt, C, Quicke, JG, Sharma, S, Skou, ST, Tveter, AT, Woolf, A, Yu, SP, and Hinman, RS
Abstract: OBJECTIVE: To develop sets of core and optional recommended domains for describing and evaluating Osteoarthritis Management Programs (OAMPs), with a focus on hip and knee Osteoarthritis (OA). DESIGN: We conducted a 3-round modified Delphi survey involving an international group of researchers, health professionals, health administrators and people with OA. In Round 1, participants ranked the importance of 75 outcome and descriptive domains in five categories: patient impacts, implementation outcomes, and characteristics of the OAMP and its participants and clinicians. Domains ranked as "important" or "essential" by ≥80% of participants were retained, and participants could suggest additional domains. In Round 2, participants rated their level of agreement that each domain was essential for evaluating OAMPs: 0 = strongly disagree to 10 = strongly agree. A domain was retained if ≥80% rated it ≥6. In Round 3, participants rated remaining domains using same scale as in Round 2; a domain was recommended as "core" if ≥80% of participants rated it ≥9 and as "optional" if ≥80% rated it ≥7. RESULTS: A total of 178 individuals from 26 countries participated; 85 completed all survey rounds. Only one domain, "ability to participate in daily activities", met criteria for a core domain; 25 domains met criteria for an optional recommendation: 8 Patient Impacts, 5 Implementation Outcomes, 5 Participant Characteristics, 3 OAMP Characteristics and 4 Clinician Characteristics. CONCLUSION: The ability of patients with OA to participate in daily activities should be evaluated in all OAMPs. Teams evaluating OAMPs should consider including domains from the optional recommended set, with representation from all five categories and based on stakeholder priorities in their local context.
Published: 2023

11. Recommendations for the delivery of therapeutic exercise for people with knee and/or hip osteoarthritis. An international consensus study from the OARSI Rehabilitation Discussion Group

Author: Holden, MA, Metcalf, B, Lawford, BJ, Hinman, RS, Boyd, M, Button, K, Collins, NJ, Cottrell, E, Henrotin, Y, Larsen, JB, Master, H, Skou, ST, Thoma, LM, Rydz, R, Wellsandt, E, White, DK, Bennell, K, Holden, MA, Metcalf, B, Lawford, BJ, Hinman, RS, Boyd, M, Button, K, Collins, NJ, Cottrell, E, Henrotin, Y, Larsen, JB, Master, H, Skou, ST, Thoma, LM, Rydz, R, Wellsandt, E, White, DK, and Bennell, K
Abstract: OBJECTIVE: To develop evidence-informed recommendations to support the delivery of best practice therapeutic exercise for people with knee and/or hip osteoarthritis (OA). DESIGN: A multi-stage, evidence-informed, international multi-disciplinary consensus process that included: 1) a narrative literature review to synthesise existing evidence; 2) generation of evidence-informed proposition statements about delivery of exercise for people with knee and/or hip OA by an international multi-disciplinary expert panel, with statements refined and analysed thematically; 3) an e-Delphi survey with the expert panel to gain consensus on the most important statements; 4) a final round of statement refinement and thematic analysis to group remaining statements into domains. RESULTS: The expert panel included 318 members (academics, health care professionals and exercise providers, patient representatives) from 43 countries. Final recommendations comprised 54 specific proposition statements across 11 broad domains: 1) use an evidence-based approach; 2) consider exercise in the context of living with OA and pain; 3) undertake a comprehensive baseline assessment with follow-up; 4) set goals; 5) consider the type of exercise; 6) consider the dose of exercise; 7) modify and progress exercise; 8) individualise exercise; 9) optimise the delivery of exercise; 10) focus on exercise adherence; and 11) provide education about OA and the role of exercise. CONCLUSION: The breadth of issues identified as important by the international diverse expert panel highlights that delivering therapeutic exercise for OA is multi-dimensional and complex.
Published: 2023

12. Long-term quality of life, work limitation, physical activity, economic cost and disease burden following ACL and meniscal injury: a systematic review and meta-analysis for the OPTIKNEE consensus

Author: Filbay, SR, Skou, ST, Bullock, GS, Le, CY, Raisanen, AM, Toomey, C, Ezzat, AM, Hayden, A, Culvenor, AG, Whittaker, JL, Roos, EM, Crossley, KM, Juhl, CB, Emery, C, Filbay, SR, Skou, ST, Bullock, GS, Le, CY, Raisanen, AM, Toomey, C, Ezzat, AM, Hayden, A, Culvenor, AG, Whittaker, JL, Roos, EM, Crossley, KM, Juhl, CB, and Emery, C
Abstract: OBJECTIVE: Determine the long-term health-related quality-of-life (HRQoL), work limitation, physical activity, health/economic cost and disease burden of traumatic ACL and/or meniscal injury. Findings will inform OPTIKNEE evidence-based consensus recommendations. DESIGN: Random-effects meta-analysis evaluated HRQoL (SF-36/SF-12/VR-12 Physical Component Scores (PCS) and Mental Component Scores (MCS), EuroQol-5D (EQ-5D)) stratified by time postinjury, and pooled mean differences (95% CI) between ACL-injured and uninjured controls. Other outcomes were synthesised descriptively. Risk-of-bias (RoB) and certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation) were assessed. DATA SOURCES: MEDLINE, EMBASE, CENTRAL, SPORTDiscus, CINAHL searched inception: 22 November 2021. ELIGIBILITY: Studies reporting HRQoL, work limitations, physical activity levels, health/economic costs or disease burden, ≥2 years post-ACL and/or meniscal injury. RESULTS: Fifty studies were included (10 high-RoB, 28 susceptible-to-some-bias and 12 low-RoB). Meta-analysis (27 studies, very low certainty of evidence) estimated a pooled mean (95% CI) PCS of 52.4 (51.4 to 53.4) and MCS of 54.0 (53.0 to 55.0) 2-14 years post-ACL injury. Pooled PCS scores were worse >10 years (50.8 (48.7 to 52.9)) compared with 2-5 years (53.9 (53.1 to 54.7)) postinjury. Excluding high-RoB studies, PCS scores were worse in ACL-injured compared with uninjured controls (-1.5 (-2.9 to -0.1)). Six studies (low certainty of evidence) informed a pooled EQ-5D score of 0.83 (0.81 to 0.84). Some individuals experienced prolonged work absenteeism and modified activities ≥2 years post-ACL injury. ACL injury was associated with significant direct and indirect costs, and early ACL reconstruction may be less cost-effective than rehabilitation. Only three studies evaluated meniscal injury outcomes (all evaluated HRQoL). CONCLUSION: There is a very-low certainty of evidence that PCS scores ≥2 years post-ACL i
Published: 2022

13. EVIDENCE-INFORMED RECOMMENDATIONS TO SUPPORT IMPLEMENTATION OF BEST PRACTICE THERAPEUTIC EXERCISE FOR PEOPLE WITH KNEE AND/OR HIP OSTEOARTHRITIS: AN INTERNATIONAL CONSENSUS PROCESS

Author: Holden, MA, Metcalf, B, Lawford, B, Hinman, R, Boyd, M, Button, K, Collins, NJ, Cottrell, E, Henrotin, Y, Larsen, JB, Master, H, Skou, ST, Thoma, LM, Rydz, R, Wellsandt, E, White, DK, and Bennell, K
Subjects: RC925, Rheumatology, Biomedical Engineering, Orthopedics and Sports Medicine, RA
Published: 2022

14. Neuromuscular Electric Stimulation in Addition to Exercise Therapy in Patients with Lower Extremity Paresis Due to Acute Ischemic Stroke. A proof-of-concept randomised controlled trial

Author: Asgari N, Lyckhage Lf, Arens Ch, Troels Wienecke, Henriette Busk, and Skou St
Subjects: Faculty of Health and Medical Sciences, Male, Time Factors, medicine.medical_treatment, Denmark, Walking, Neuromuscular electrical stimulation, law.invention, Quadriceps Muscle, Randomized controlled trial, law, Acute stroke, Paresis/diagnosis, Ischemic Stroke/complications, Stroke, Depression (differential diagnoses), Paresis, Aged, 80 and over, Rehabilitation, Leg paresis, Stroke Rehabilitation, Montreal Cognitive Assessment, Middle Aged, Combined Modality Therapy, Exercise Therapy, Treatment Outcome, Lower Extremity, Quadriceps Muscle/innervation, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, Stroke recovery, Adult, medicine.medical_specialty, Exercise therapy, Electric Stimulation Therapy, 6 min Walking Test, Proof of Concept Study, medicine, Humans, Aged, Ischemic Stroke, business.industry, Recovery of Function, medicine.disease, Gait, Functional Status, Physical therapy, Surgery, Neurology (clinical), business
Abstract: Introduction: Exercise therapy and neuromuscular electrical stimulation (NMES) during the initial 14 days after stroke may benefit recovery of gait. We aimed to determine whether poststroke NMES of vastus medial and tibial muscles during exercise therapy is more effective than exercise therapy alone.Materials and methods: In this proof-of-concept randomised trial patients with first-ever acute ischemic stroke and a leg paresis (40-85 years of age) were randomised (1:1) to 10 min of daily NMES + exercise therapy or exercise therapy alone. Primary outcome was the between-group difference in change in 6 min Walk Test (6MWT) at 90 days post stroke estimated with a mixed regression model. Secondary outcomes included 10 m Walk Test, Fugl-Meyer Motor Assessment, Guralnik Timed Standing Balance, Sit to Stand, Timed Up and Go, EQ-5D-5L, Montreal Cognitive Assessment and Becks Depression Inventory.Results: 50 stroke survivors (25 in each group) with a mean age of 67 years (range 43-83) were included. An insignificant between-group difference in change of 28.3 m (95%CI -16.0 to 72.6, p = 0.23, adjusted for baseline) in 6MWT at 90-days follow-up was found, in favour of the NMES group. All secondary outcomes showed no statistically significant between-group difference. The conclusion was that adding NMES to exercise therapy had no effect on poststroke walking distance measured by the 6 MWT or any of the secondary outcomes.Conclusions: In this proof-of-concept RCT, we demonstrated that NMES in addition to exercise therapy during the first 14 days after onset of ischemic stroke did not improve walking distance or any of the secondary outcomes. Future studies with a longer trial period, stratifying patients into subgroups with comparable patterns of expected spontaneous recovery - if possible within 48 h post stroke, and greater sample size, than in this study are suggestions of how rehabilitation research could go on exploring the potential for NMES as an amplifier in stroke recovery.
Published: 2021

15. Program evaluation of GLA:D® Australia: Physiotherapist training outcomes and effectiveness of implementation for people with knee osteoarthritis.

Author: Barton, CJ, Kemp, JL, Roos, EM, Skou, ST, Dundules, K, Pazzinatto, MF, Francis, M, Lannin, NA, Wallis, JA, Crossley, KM, Barton, CJ, Kemp, JL, Roos, EM, Skou, ST, Dundules, K, Pazzinatto, MF, Francis, M, Lannin, NA, Wallis, JA, and Crossley, KM
Abstract: OBJECTIVE: Evaluate the implementation of Good Life with osteoArthritis from Denmark (GLA:D®) for knee osteoarthritis in Australia using the RE-AIM QuEST (Reach, Effectiveness, Adoption, Implementation, Maintenance Qualitative Evaluation for Systematic Translation) framework. DESIGN: Physiotherapists completed surveys before and after GLA:D® training (2017-2020) to assess practices, and barriers and enablers to implementation. Patients completed online baseline, 3-month (post-treatment) and 12-month patient reported outcomes. Effective implementation was defined as within-participant moderate effect size (ES, ≥0.50) for average pain (100 mm VAS) and Knee Injury and Osteoarthritis Outcome Score quality of life scores (KOOS-QoL), and small effect size (≥0.20) for health-related quality of life (EQ-5D-5L). RESULTS: Reach : 1064 physiotherapists and 1945 patients from all states and territories participated. Key barriers included out-of-pocket cost to patients, and program suitability for culturally and linguistically diverse communities. Effectiveness: Following training, more physiotherapists reported discussing treatment goals and weight management, and prescribing supervised, neuromuscular exercise. Patient outcomes at 3- and 12-months (n = 1044 [54%] and 927 [48%]) reflected effective implementation, including reduced pain (ES, 95%CI = 0.72, 0.62-0.84; and 0.65, 0.54-0.77) and improved KOOS-QoL (0.79, 0.69-0.90; and 0.93, 0.81-1.04) and EQ-5D-5L (0.43, 0.31-0.54; and 0.46, 0.35-0.58) scores. Adoption: 297 sites (264 private, 33 public) implemented GLA:D®. Implementation: Most patients completed at least one education (90%), and 10 exercise-therapy (78%) sessions. Adequate staffing to support program delivery was a key enabler. Maintenance: 99% of sites (293/297) continued offering the program in July 2020. CONCLUSION: Training changed practice and was associated with effective widespread implementation of GLA:D® in Australia.
Published: 2021

16. Guidance for Implementing Best Practice Therapeutic Exercise for Patients With Knee and Hip Osteoarthritis: What Does the Current Evidence Base Tell Us?

Author: Holden, MA, Button, K, Collins, NJ, Henrotin, Y, Hinman, RS, Larsen, JB, Metcalf, B, Master, H, Skou, ST, Thoma, LM, Wellsandt, E, White, DK, Bennell, K, Holden, MA, Button, K, Collins, NJ, Henrotin, Y, Hinman, RS, Larsen, JB, Metcalf, B, Master, H, Skou, ST, Thoma, LM, Wellsandt, E, White, DK, and Bennell, K
Abstract: Therapeutic exercise is a recommended first-line treatment for patients with knee and hip osteoarthritis (OA); however, there is little specific advice or practical resources to guide clinicians in its implementation. As the first in a series of projects by the Osteoarthritis Research Society International Rehabilitation Discussion Group to address this gap, we aim in this narrative review to synthesize current literature informing the implementation of therapeutic exercise for patients with knee and hip OA, focusing on evidence from systematic reviews and randomized controlled trials. Therapeutic exercise is safe for patients with knee and hip OA. Numerous types of therapeutic exercise (including aerobic, strengthening, neuromuscular, mind-body exercise) may be utilized at varying doses and in different settings to improve pain and function. Benefits from therapeutic exercise appear greater when dosage recommendations from general exercise guidelines for healthy adults are met. However, interim therapeutic exercise goals may also be useful, given that many barriers to achieving these dosages exist among this patient group. Theoretically-informed strategies to improve adherence to therapeutic exercise, such as patient education, goal-setting, monitoring, and feedback, may help maintain participation and optimize clinical benefits over the longer term. Sedentary behavior is also a risk factor for disability and lower quality of life in patients with knee and hip OA, although limited evidence exists regarding how best to reduce this behavior. Current evidence can be used to inform how to implement best practice therapeutic exercise at a sufficient and appropriate dose for patients with knee and hip OA.
Published: 2021

17. Implementing a national first-line management program for moderate-severe knee osteoarthritis in Australia: A budget impact analysis focusing on knee replacement avoidance.

Author: Ackerman, IN, Skou, ST, Roos, EM, Barton, CJ, Kemp, JL, Crossley, KM, Liew, D, Ademi, Z, Ackerman, IN, Skou, ST, Roos, EM, Barton, CJ, Kemp, JL, Crossley, KM, Liew, D, and Ademi, Z
Abstract: OBJECTIVE: To model potential cost savings associated with implementing a first-line management program for moderate-severe knee osteoarthritis (OA) at a national level in Australia. METHODS: A budget impact analysis was undertaken using published trial data and publically available data. Australian population projections and OA prevalence data were used to forecast likely need for total knee replacement (TKR) surgery for 2019-2029. Published data were sourced on TKR avoidance following a 12-week non-surgical knee OA management program (exercise therapy, education, insoles, dietary advice, analgesia) and cost per TKR in Australia. The cost of providing the first-line program was estimated on a sliding scale ($AUD750-$3000), with a base case of $AUD1,500. These inputs were used to model potential annual savings associated with national implementation of the program. RESULTS: The number of people in Australia with moderate-severe knee OA requiring TKR was estimated to be 56,007 in 2019, rising to 69,038 by 2029. Avoidance of TKR by 34%-68% of people after the first-line management program could translate to savings of $AUD303million-690 million in 2019. Successively lowering the proportion of people who avoided TKR demonstrated that only 1 in 12 program recipients would need to avoid surgery for the program to generate savings. CONCLUSIONS: National implementation of a first-line OA management program as an alternative to TKR could produce substantial cost savings for the Australian healthcare system. Longer term data on TKR avoidance is needed to establish whether cost savings are realised or simply shifted to later years.
Published: 2020

18. Comorbidities and their link with individual health status: A cross-sectional analysis of 23,892 people with knee and hip osteoarthritis from primary care

Author: Muckelt, Paul Edward, primary, Roos, EM, additional, Stokes, M, additional, McDonough, S, additional, Grønne, DT, additional, Ewings, S, additional, and Skou, ST, additional
Published: 2020
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19. Impact of prior knee surgery on change in knee pain, quality of life, and walking speed following supervised education and exercise therapy: an analysis of 30,545 people with knee osteoarthritis.

Author: Grønne DT, Sari DM, Skou ST, Roos EM, Demirbüken I, and Thorlund JB
Abstract: To investigate the impact of prior knee surgery on changes in outcomes following an 8-week supervised patient education and exercise therapy program in patients with knee osteoarthritis. Patients were classified according to knee surgery in the most affected knee joint (yes/no) prior to enrolment in the Good Life with osteoArthritis in Denmark (GLA:D ® ) program. Between-group differences in outcome changes from baseline to 3 months follow-up were evaluated using linear regression stratified by sex. Outcomes were knee pain intensity (VAS, 0-100 mm), joint related quality of life (Knee Injury and Osteoarthritis Outcome Score Quality of Life subscale score (KOOS QOL, 0-100)) and walking speed (40-m fast-paced walk test). To evaluate clinically relevant between-group differences, proportions of patients reaching a threshold of minimal important change in the surgery and non-surgery groups were compared. Among 30,545 patients, 27% (n, 8254) had prior surgery in the most affected knee. The prior surgery and the non-surgery group experienced improvements in all outcomes with minor between-group differences in change in pain intensity (males, 0.03 95% CI - 0.9 to 1.0; females, 1.3 95% CI 0.6 to 2.1); KOOS QOL (males, 0.3 95% CI - 0.4 to 0.9; females 0.02 95% CI - 0.5 to 0.5); and walking speed (males, 0.01 95% CI - 0.01 to 0.02; females 0.01 95% CI 0.003 to 0.02). The responder analysis showed no clinically relevant between-group differences in improvements. Previous knee surgery does not seem to modify the clinical outcome following exercise therapy and patient education in patients with knee osteoarthritis., (© 2024. The Author(s).)
Published: 2024
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20. At home e-based physical exercise programs in patients with multiple sclerosis: a scoping review.

Author: Adnan R, Roikjaer SG, Samadzadeh S, Richter CJ, Weinshenker BG, Paul F, Skou ST, Dalgas U, and Asgari N
Abstract: Introduction: Physical exercise (PE) improves symptoms and quality of life in people with multiple sclerosis (pwMS). However, incorporating PE into daily lives of pwMS pose difficulties. As an alternative to in-person PE, e-based PE has been proposed because of its advantages in terms of accessibility and convenience., Objective: To synthesize existing evidence on e-based PE at home in adults MS and discuss study designs, rehabilitation programs, intervention effects and possible knowledge gaps., Methods: In this scoping review, a systematic search in electronic databases including Embase, Medline, CINAHL and Cochrane Library was conducted following the PRISMA guidelines. Peer-reviewed articles in English on e-based PE interventional studies at home involving adult pwMS, published from 2008 until April 2023, were identified and exported to Covidence. Data from the included studies were extracted and synthesized. This scoping review identified different types of e-based PE interventions used in pwMS across different study designs, but when evaluating intervention effects, this review focused solely on randomized controlled trials (RCTs)., Results: A total of 3,006 studies were retrieved and 179 studies were screened in full text, resulting in the inclusion of 54 studies with a total of 2,359 pwMS. Of those, 33 were RCTs and three were qualitative studies. The studies reported on various e-based interventions including video-based programs, telerehabilitation, and web-based programs. The interventions evaluated muscle strength, cardiorespiratory fitness, walking speed, endurance, balance, and fatigue, as well as symptoms of depression and cognitive dysfunction. E-based PE interventions at home in RCTs demonstrated improvement of depressive symptoms and anxiety, while inconsistent results were reported for fatigue, walking speed and balance. No significant benefits were observed regarding dexterity. Results were generally heterogeneous and were limited by small sample sizes. Several limitations were identified, such as lack of physical activity assessment prior to the intervention and poor reporting of duration, intensity, frequency and adherence to e-based PE interventions., Conclusion: E-based PE interventions in pwMS may improve MS-related symptoms, but the study quality is generally low, and findings are often inconsistent. Several important limitations of the existing literature have been identified in the present review, which can guide future research., Competing Interests: BW receives royalties from RSR Ltd, Oxford University, Hospices Civil de Lyon, and MVZ Labor PD Dr. Volkmann und Kollegen GbR for a patent of NMO-IgG as a diagnostic test for neuromyelitis optica spectrum disorders, served on adjudication committee for clinical trials conducted by MedImmune/VielaBio, Alexion, and UCB Biosciences and consulted for Chugai/Roche/Genentech, Horizon Therapeutics and Mitsubishi-Tanabe regarding neuromyelitis optica spectrum disorders. He has received honoraria for speaking at internal meetings of Genentech, Novartis, and Horizon and at external meetings for Roche. FP served on the scientific advisory boards of Novartis and MedImmune; received travel funding and/or speaker honoraria from Bayer, Novartis, Biogen, Teva, Sanofi-Aventis/Genzyme, Merck Serono, Alexion, Chugai, MedImmune, and Shire; is an associate editor of Neurology: Neuroimmunology & Neuroinflammation; is an academic editor of PLoS ONE; consulted for Sanofi Genzyme, Biogen, MedImmune, Shire, and Alexion; received research support from Bayer, Novartis, Biogen, Teva, Sanofi-Aventis/Geynzme, Alexion, and Merck Serono; and received research support from the German Research Council, Werth Stiftung of the City of Cologne, German Ministry of Education and Research, Arthur Arnstein Stiftung Berlin, EU FP7 Framework Program, Arthur Arnstein Foundation Berlin, Guthy-Jackson Charitable Foundation, and NMSS. SSk received personal fees from Munksgaard, TrustMe-Ed, and Nestlé Health Science, outside the submitted work, and co-founder of GLA:D®, a not-for profit initiative hosted at University of Southern Denmark aimed at implementing clinical guidelines for osteoarthritis in clinical practice. SSk was funded by a program grant from Region Zealand (Exercise First) and two grants from the European Union's Horizon 2020 research and innovation program, one from the European Research Council (MOBILIZE, grant agreement No. 801790) and the other under grant agreement No. 945377 (ESCAPE). UD has received research support, travel grants and/or teaching honorary from Biogen, Merck Serono, Novartis, Bayer Schering and Sanofi Aventis as well as honoraria from serving on scientific meetings of Biogen and Sanofi Genzyme. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Adnan, Roikjaer, Samadzadeh, Richter, Weinshenker, Paul, Skou, Dalgas and Asgari.)
Published: 2024
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21. The effectiveness of digital health interventions for the maintenance of physical activity following cardiac rehabilitation: A systematic review and meta-analysis.

Author: Luijk A, Mortensen SR, Hamborg TG, Zangger G, Ahler JR, Christensen J, Skou ST, and Tang LH
Abstract: Objective: To summarise the effectiveness of digital health maintenance interventions for subjectively and objectively measured physical activity level (PA) and physical function, fitness and health-related quality of life (HRQoL) after completion of phase II cardiac rehabilitation (CR)., Methods: We conducted a search for studies in MEDLINE, Embase, CENTRAL, and CINAHL (inception to May 2024). Independent reviewers selected and included randomised controlled trials (RCTs) using digital health interventions to maintain PA in patients with cardiovascular disease after phase II CR. Independent reviewers conducted data extraction, assessed the risk of bias using the Cochrane Risk of Bias 2 tool and rated the certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation - registered at PROSPERO: CRD42023396629., Results: From 17,455 hits, 20 RCTs with 1801 participants were included. Risk of bias for most studies reporting on PA outcomes was rated as 'some concerns'. Comparing digital health intervention with minimal intervention/usual care showed no effect of objective PA (standardised mean difference (SMD) 0.85, 95% CI: -0.07 to 1.77) and a small effect of subjective PA (SMD 0.37, 95% CI: 0.05 to 0.69) at the end of intervention both graded as very low certainty of evidence. We found very low certainty of evidence for moderate effects on physical function (SMD 0.63, 95% CI: 0.03 to 1.24), and low certainty of evidence for no effect on physical fitness (SMD 0.19, 95% CI: 0.05 to 0.34) and HRQoL (SMD 0.13, 95% CI: -0.02 to 0.28), I 2 = 0.00%) at the end of intervention., Conclusion: Digital health interventions showed a small effect on subjectively measured PA, and no effect on objective PA, physical fitness and HRQoL, but may increase physical function after CR completion. Yet, the certainty of evidence is low and higher quality studies with longer follow-up duration are needed to guide this area further., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)
Published: 2024
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22. Prevalence of concerns about falling in people with knee or hip osteoarthritis and the association with pain, function, and psychological factors-a cross-sectional study of 7442 patients treated in primary care.

Author: Grønne DT, Ryg J, Rubin KH, Delbaere K, Roos EM, and Skou ST
Subjects: Humans, Female, Male, Cross-Sectional Studies, Aged, Prevalence, Middle Aged, Denmark epidemiology, Risk Factors, Registries, Functional Status, Pain Measurement, Primary Health Care, Osteoarthritis, Hip psychology, Osteoarthritis, Hip epidemiology, Osteoarthritis, Hip diagnosis, Accidental Falls statistics & numerical data, Osteoarthritis, Knee psychology, Osteoarthritis, Knee epidemiology
Abstract: Background: Concerns about falling (CaF) are common in older people and can lead to avoidance of activities, social isolation and reduced physical function. However, there is limited knowledge about CaF in people with osteoarthritis (OA); yet, symptoms may increase CaF. We aimed to evaluate the prevalence of CaF and associated factors in people with knee or hip OA., Methods: This cross-sectional study used data from the Good Life with osteoArthritis in Denmark registry including patients with OA treated in primary care. CaF was assessed with the Short Falls Efficacy Scale International (Short FES-I, range 7-28, low to high). Associations between CaF and pain, function and psychological factors were evaluated using multivariable linear Tobit regression., Results: In total, 7442 patients were included [mean age 67 years (SD: 9.6), 67% females]. Mean Short FES-I was 9.8 [95% confidence interval (CI): 9.7; 9.8]. Moderate CaF was observed in 48.1% (95% CI: 46.7; 48.9) of participants, whilst 11.3% (95% CI: 10.7; 12.1) had a high level of CaF. CaF was more prevalent in the oldest participants and in females. Pain intensity [β-value (95% CI): 0.52 (0.48; 0.55)], chair stand test [-0.21 (-0.22; -0.19)] and fear of movement [1.38 (1.19; 1.56)] were significantly associated with increased CaF across age groups and sex., Conclusions: CaF is common in people with OA, especially in the oldest participants and in females. Higher pain, lower function and psychological distress are associated with CaF; yet, the causality of the associations remain to be determined. Integrating CaF assessments and interventions into OA management in primary care seems highly relevant., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Published: 2024
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23. Evaluation of the Nordic Musculoskeletal Questionnaire for Measuring Prevalence and the Consequence of Pain in a Danish Adult OI Population: A Pilot Study.

Author: Horn CG, Jensen K, Hartvigsen J, Wekre LL, Skou ST, and Folkestad L
Subjects: Humans, Pilot Projects, Adult, Female, Male, Surveys and Questionnaires, Prevalence, Denmark epidemiology, Middle Aged, Cross-Sectional Studies, Pain Measurement methods, Young Adult, Activities of Daily Living, Musculoskeletal Pain epidemiology, Musculoskeletal Pain diagnosis, Osteogenesis Imperfecta epidemiology, Osteogenesis Imperfecta complications
Abstract: Pain is a challenge in persons with OI and causes much concern in the Osteogenesis Imperfecta (OI) population. We aim to evaluate the usability of the Nordic Musculoskeletal Questionnaire (NMQ) to identify painful sites in adults with OI and to describe the occurrence of musculoskeletal (MSK) pain and its impact on their work and daily activities. This cross-sectional pilot study uses the OI-NMQ to study MSK pain prevalence in nine separate anatomical regions (neck, upper back, lower back, shoulder, elbow, hand/wrist, hip, knee, and ankle/foot) and its impact on regular work and daily activities in adults with OI. The questionnaire was distributed among participants of the 2023 annual meeting of The Danish OI Society. The response rate was 68%, and all participants considered the OI-NMQ helpful in assessing the presence of pain and its consequences. The analysis included 27 adults with OI type I, III, or IV above 18 years. Among all 27 participants, MSK pain was present in 15-56% of the 9 sites within the last 7 days and 33-89% of the nine anatomical regions during the last 12 months. In 7-48% of all the participants, their regular work and daily activities had been affected by the presence of MSK pain. The OI-NMQ was feasible in assessing MSK pain among adults with OI and displayed a high prevalence of MSK pain with a moderate impact on their regular work and daily activities in this OI population. A larger and repeated measurement of MSK pain in adults with OI is needed to confirm these results., (© 2024. The Author(s).)
Published: 2024
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24. GLA:D to Be Walking Better: Change in Self-Reported Difficulty Walking After Exercise Therapy and Education in Persons With Knee Osteoarthritis.

Author: King LK, Young JJ, Grønne DT, Bricca A, Roos EM, Skou ST, and Hawker GA
Subjects: Humans, Female, Male, Middle Aged, Aged, Denmark, Treatment Outcome, Registries, Severity of Illness Index, Patient Education as Topic, Quality of Life, Cohort Studies, Osteoarthritis, Knee therapy, Osteoarthritis, Knee rehabilitation, Osteoarthritis, Knee physiopathology, Walking, Self Report, Exercise Therapy methods
Abstract: Objective: Difficulty walking is a primary reason that individuals with knee osteoarthritis (OA) seek care. We examined the change in self-reported difficulty walking after participating in the Good Life With Osteoarthritis in Denmark (GLA:D) 8-week education and exercise program and assessed patient factors associated with improvement in difficulty walking., Methods: This was a registry-based cohort study of individuals in Denmark with knee OA who enrolled in GLA:D. Assessments were administered at baseline, program completion (~3 months), and 12 months. Our prespecified primary outcome was change in self-reported difficulty walking assessed using the EuroQol 5-dimension 5-level walking item. Exposures included sociodemographic factors, measures of OA illness severity, comorbidities, and psychological factors. In those with baseline moderate/severe difficulty walking, using multivariable regression analysis, we assessed the relationship between exposures of interest and improvement to no/slight difficulty walking., Results: We included 5262 participants. Of 2178 (41.4%) individuals with baseline moderate/severe difficulty walking, 51.4% and 58.3% reported no/slight difficulty walking at 3 and 12 months, respectively. Greater self-efficacy, younger age, female sex, lower BMI, less intense knee pain, and better function at baseline were associated with greater likelihood of improvement in difficulty walking, whereas severe difficulty walking at baseline and back pain intensity were associated with decreased likelihood of improvement., Conclusion: More than half of those with baseline difficulty walking experienced substantial improvement after completing GLA:D and this improvement was maintained at 12 months. Several patient factors were associated with the outcome, suggesting that some individuals may require additional support and extended treatment., (Copyright © 2024 by the Journal of Rheumatology.)
Published: 2024
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25. Long-term self-reported attendance in exercise training or lung choir and status of quality of life following initial pulmonary rehabilitation for COPD.

Author: Kaasgaard M, Bodtger U, Skou ST, Clift S, Hilberg O, Rasmussen DB, and Løkke A
Abstract: Background: Both adherence rates to pulmonary rehabilitation (PR) programmes and long-term attendance in exercise training after PR remain a challenge. In our previous randomised controlled trial (RCT), effects were positively associated with a dose-response pattern, regardless of whether PR contained conventional physical exercise training (PExT) or Singing for Lung Health (SLH) as a training modality within a 10 weeks' PR programme for chronic obstructive pulmonary disease (COPD). However, long-term status of this RCT cohort remains unknown. In this study, we investigated whether current status (=attendance in supervised exercise training or a lung choir and scoring in quality of life (QoL)) was related to initial PR completion, randomisation, or adherence., Methods: We collected data via telephone, using a researcher-developed questionnaire on current self-reported attendance in supervised exercise training or a lung choir and on perceived benefits of the initial RCT intervention. Additionally, we used COPD-validated questionnaires (primarily: QoL (measure: St George's Respiratory Questionnaire; SGRQ)., Results: In 2023 (i.e., mean/median 4.7 years after initial PR), surviving participants were contacted ( n = 196; 73% of 270), and 160 (82% of 196) were included. Out of the included participants, 30 (19%) had not completed initial PR. Compared to the initial PR-completers, non-completers reported less current attendance in exercise training or lung choir (24% vs. 46%, p = 0.03) but SGRQ scores were comparable. Yet, those who attended exercise training or lung choir at present ( n = 66/160; 41% out of 160) reported better QoL score than those with no current attendance (SGRQ; Attending: 39.9 ± 15.4; Not attending: 43.1 ± 16.7; p = 0.02). Neither having had SLH instead of PExT, nor adherence level during initial PR, was related to current attendance or to QoL scores., Conclusion: This study indicates that long-term self-reported attendance and current QoL scores are positively related to initial completion of a PR programme. Surprisingly, neither initial PR content (PExT or SLH) nor initial PR adherence was related to long-term outcomes. We suggest that future PR programmes include special attention to those who do not complete PR to support long-term attendance and QoL status., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Kaasgaard, Bodtger, Skou, Clift, Hilberg, Rasmussen and Løkke.)
Published: 2024
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26. Associations between changes in leg extensor muscle power and physical function after supervised exercise in patients with hip osteoarthritis. Secondary analysis from the hip booster trial.

Author: Kjeldsen T, Dalgas U, Skou ST, Foldager FN, Bibby BM, and Mechlenburg I
Abstract: Objective: To investigate associations between changes in leg extensor muscle power of the affected limb (ΔLEP) and changes in physical function after 12 weeks of progressive resistance training (PRT) or neuromuscular exercise (NEMEX) in patients with hip osteoarthritis., Design: Secondary analyses of a randomized controlled trial. From 160 participants enrolled in the clinical trial and cluster randomized to PRT (n = 82) or NEMEX (n = 78), a total of 147 (92%) had complete follow-up data and were included in the analyses. Simple linear and multivariate linear regression models estimated the crude and adjusted associations between ΔLEP normalized to body weight (watt/kg) and changes in performance-based and patient-reported measures of physical function., Results: Adjusted estimates [95% confidence intervals] showed associations between ΔLEP (watt/kg) and changes in 30-s chair stand test (β: 2.34 [1.33; 3.35], R 2 : 0.13), 9-step timed stair climb test (β: -1.47 [-2.09; -0.85], R 2 : 0.38), 40-m fast paced walking test (β: -2.20 [-3.30; -1.11], R 2 : 0.09), Activities of Daily Life function (β: 8.63 [3.16; 14.10], R 2 : 0.23) and Sport and Recreation function (β: 10.57 [2.32; 18.82], R 2 : 0.21) subscales from the Hip disability and Osteoarthritis Outcomes Score. Group allocation to PRT did not lead to greater regression coefficients than in NEMEX., Conclusions: Changes in leg extensor muscle power after supervised exercise are consistently associated with changes in physical function across performance-based and patient-reported measures in patients with hip osteoarthritis. These associations seem to be independent of allocation to PRT or NEMEX., Competing Interests: TK, UD and IM have worked extensively with PRT. STS is co-lead of the Danish initiative, Good Life with osteoArthritis in Danmark (GLA:D), which entails NEMEX and has received personal fees from Munksgaard, TrustMe-Ed, and Nestlé Health Science, outside the submitted work., (© 2024 The Authors.)
Published: 2024
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27. From Hands to Words-Physiotherapists Experience of Delivering Online Exercise and Education for Individuals With Knee Osteoarthritis.

Author: Bødtger D, Simonÿ C, Tang LH, Skou ST, and Holm PM
Subjects: Humans, Female, Patient Education as Topic, Telemedicine, Male, Qualitative Research, Middle Aged, Attitude of Health Personnel, Denmark, Adult, Osteoarthritis, Knee rehabilitation, Osteoarthritis, Knee therapy, Physical Therapists education, Physical Therapists psychology, Exercise Therapy
Abstract: Background: Little is known about delivering telehealth from a healthcare provider's perspective., Purpose: To investigate physiotherapists' (PTs) experiences in delivering live online exercise and education for people with knee osteoarthritis (OA)., Methods: This was a qualitative individual interview study with a thematic analysis approach. The interviewees were six PTs delivering 8 weeks of supervised online exercise and education for people with knee OA in secondary public care in Denmark., Results: The three main themes were (1) From hands to words-on the transition from on-site to on-line physiotherapy, (2) Online selection-on the perceived barriers to managing a telehealth service and (3) Therapeutic relation under pressure-on the contextual difficulties in building relationships and alliances in online classes., Conclusion: The PTs in this study seemed to gradually come to terms with delivering first-line OA care online, appreciating advantages and new possibilities. PTs' initial apprehension towards this new form of physiotherapy service may be rooted in the traditional conception of physiotherapy as a predominantly manual profession but also in a lack of formal training in physiotherapy telehealth services. This study underlines the growing need for better and more formalised training in physiotherapy telehealth services to meet growing demands., (© 2024 The Author(s). Musculoskeletal Care published by John Wiley & Sons Ltd.)
Published: 2024
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28. Total Hip Arthroplasty Versus Education and Exercise: A Propensity-Matched Analysis of 266 Patients Who Have Hip Osteoarthritis.

Author: Young JJ, Zywiel MG, Skou ST, Chandran V, Davey JR, Gandhi R, Mahomed NN, Syed K, Veillette CJH, Rampersaud YR, and Perruccio AV
Subjects: Humans, Female, Male, Middle Aged, Aged, Treatment Outcome, Patient Education as Topic, Arthroplasty, Replacement, Hip, Osteoarthritis, Hip surgery, Quality of Life, Propensity Score, Exercise Therapy methods
Abstract: Background: Total hip arthroplasty (THA) for osteoarthritis (OA) is a major health system cost. Education and exercise (Edu + Ex) programs may reduce the number of THAs needed, but supporting data are limited. This study aimed to estimate the treatment effect of THA versus Edu + Ex on pain, function, and quality of life outcomes 3 and 12 months after treatment initiation for hip OA., Methods: Patients who had hip OA who underwent THA or an Edu + Ex program were included in this propensity-matched study. In 778 patients (Edu + Ex, n = 303; THA, n = 475), propensity scores were based on pretreatment characteristics, and patients were matched on a 1:1 ratio. Between-group treatment effects (pain, function, and quality of life) were estimated as the mean difference (MD) in change from pretreatment to 3-month and 12-month follow-up using linear mixed models., Results: The matched sample consisted of 266 patients (Edu + Ex, n = 133; THA, n = 133) who were balanced on all pretreatment characteristics except opioid use. At 12-month follow-up, THA resulted in significantly greater improvements in pain (MD 35.4; 95% confidence interval [CI] 31.4 to 39.4), function (MD 30.5; 95% CI 26.3 to 34.7), and quality of life (MD 33.6; 95% CI 28.8 to 38.4). Between 17% and 30% of patients receiving Edu + Ex experienced a surgical threshold for clinically meaningful improvement in outcomes, compared to 84% and 90% of THA patients., Conclusions: A THA provides greater improvements in pain, function, and quality of life. A notable proportion of Edu + Ex patients had clinically meaningful improvements, suggesting Edu + Ex may result in THA deferral in some patients, but confirmatory trials are needed., (Copyright © 2024 Elsevier Inc. All rights reserved.)
Published: 2024
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29. Physiotherapists' Treatment Strategies and Delineation of Areas of Responsibility for People With Musculoskeletal Conditions and Comorbidities in Private Physiotherapy Practice: A Qualitative Study.

Author: Lyhnebeck AB, Risør MB, Guassora AD, Andersen JS, and Skou ST
Subjects: Humans, Male, Female, Comorbidity, Adult, Physical Therapy Modalities, Middle Aged, Musculoskeletal Diseases therapy, Musculoskeletal Diseases rehabilitation, Physical Therapists, Qualitative Research, Focus Groups
Abstract: Background: Patients with multiple chronic conditions, for example, musculoskeletal conditions and comorbidities, often receive inadequate and sometimes even contradictory care. Physiotherapists are well qualified to manage patients with musculoskeletal conditions and comorbidities due to their education and experience with rehabilitation; however, it is unknown which challenges they face when treating these patients., Aim: To identify challenges, treatment strategies, and delineations of areas of responsibility among physiotherapists working in private physiotherapy practice when treating people with musculoskeletal conditions and comorbidities., Methods: Qualitative study using focus group discussions and participant observations of 13 physiotherapists working in Danish private physiotherapy clinics. Grounded theory was applied to guide the analysis., Results: Two major themes emerged from the focus groups and the observations (1) The necessity of adapting management to the patients and their treatment trajectory; (2) The dilemma of overall responsibility for coordinating care. The physiotherapists described different elements of adapting their management, including being challenged on time, taking extra care of the patient, and having to adjust to a fluctuating course of treatment. The dilemma in coordinating care concerned whether the responsibility should lie with the physiotherapist, other healthcare professionals, or the patients, and whether to treat only the condition on the referral or to treat all the conditions the patient had., Conclusion: Physiotherapists use adapted strategies for diagnosing and treating patients with musculoskeletal conditions and comorbidities and are uncertain about the overall responsibility for coordinating care and whether they should focus on the index condition alone or also the other comorbidities the patient has., (© 2024 The Author(s). Musculoskeletal Care published by John Wiley & Sons Ltd.)
Published: 2024
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30. Nature-Based Group Exercises for People With Arthritis: A Qualitative Along-Side Interview Study of Lived Experiences.

Author: Knudsen JB, Simonÿ C, Tang LH, Skou ST, and Beck M
Subjects: Humans, Male, Female, Middle Aged, Aged, Denmark, Adult, Qualitative Research, Exercise Therapy methods, Exercise Therapy psychology, Arthritis psychology, Arthritis therapy, Arthritis rehabilitation, Interviews as Topic
Abstract: Arthritis affects many individuals and can cause pain and limit physical functioning. Exercise is an important treatment option for individuals with arthritis; however, adherence to exercise programs can be challenging. A new initiative in Denmark has introduced nature-based exercises for patients with arthritis. This qualitative study aimed to explore the experiences of the individuals who participated in those exercises. The study used a hermeneutic-phenomenological approach and conducted along-side interviews with 12 women and three men who participated in nature-based exercise programs for arthritis. Analysis of the data revealed two main themes. The first theme highlighted the positive effects of being in nature, such as increased vitality, reduced pain, and a sense of well-being. The second theme emphasized the social benefits of participating in these exercises, including a sense of connection and community with others. Overall, this study suggests that incorporating nature-based exercises in treatment programs for arthritis could have significant benefits for individuals with this condition., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: STS is associate editor of the Journal of Orthopaedic and Sports Physical Therapy, has received personal fees from Munksgaard, TrustMe-Ed, and Nestlé Health Science, outside the submitted work, and is co-founder of GLA:D®, a not-for-profit initiative hosted at the University of Southern Denmark aimed at implementing clinical guidelines for osteoarthritis in clinical practice. The authors have no other potential conflicts to disclose.
Published: 2024
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31. Collaborative model of care between orthopaedics and allied healthcare professionals (CONNACT) in knee osteoarthritis: Effectiveness-implementation hybrid randomized controlled trial of a community-based, multidisciplinary, stratified intervention.

Author: Tan BY, Yang SY, Pereira MJ, Tan CY, Lim CJ, Ng JP, Lee KT, Pua YH, Briggs AM, Hunter DJ, Skou ST, Thumboo J, and Car J
Subjects: Aged, Female, Humans, Male, Middle Aged, Allied Health Personnel, Exercise Therapy methods, Orthopedics, Patient Care Team, Quality of Life, Single-Blind Method, Cost-Benefit Analysis, Osteoarthritis, Knee therapy, Osteoarthritis, Knee rehabilitation
Abstract: Objective: To compare the clinical and cost effectiveness of the Collaborative Model of Care between Orthopaedics and Allied Healthcare Professionals (CONNACT), a community-based, stratified, multidisciplinary intervention consisting of exercise, education, psychological and nutrition delivered through a chronic care model to usual hospital care in adults with knee osteoarthritis (OA)., Methods: Pragmatic, parallel-arm, single-blinded superiority RCT trial. Community-dwelling, ambulant adults with knee OA (Kellgren-Lawrence grade > 1; Knee Injury and OA Outcome Score (KOOS 4 ) ≤75) were enrolled. Primary outcome was KOOS 4 at 12-months; secondary outcomes included: quality of life, physical performance measures, symptom satisfaction, psychological outcomes, dietary habits, and global perceived effect. Intention-to-treat analysis using generalized linear model (GLM) and regression modeling were conducted. Economic evaluation through a societal approach was embedded., Results: 110 participants (55 control, 55 intervention) were randomized. No between-group difference found for the primary outcome (MD [95%CI]: -1.86 [-9.11. 5.38]), although both groups demonstrated within-group improvement over 12-months. Among the secondary outcomes, the CONNACT group demonstrated superior dietary change (12 months) and physical performance measures (3 months), and global perceived effect (6 months). While there was no between-group difference in total cost, significant productivity gains (reduced indirect cost) were seen in the CONNACT group., Conclusion: CONNACT was not superior to usual care at 1 year. Further efforts are needed to understand the underlying contextual and implementation factors in order to further improve and refine such community-based, stratified care models moving forward., Trial Registration: Clinicaltrials.gov Identifier: NCT03809975. Registered January 18, 2019. https://clinicaltrials.gov/ct2/show/NCT03809975., (Copyright © 2024 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.)
Published: 2024
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32. Protocol of a prospective multicenter study on comorbidity impact on multiple sclerosis and antibody-mediated diseases of the central nervous system (COMMIT).

Author: Samadzadeh S, Adnan R, Berglova P, Barzegar M, Debrabant B, Roikjaer SG, Levy M, Petzold A, Palace J, Flanagan EP, Mariotto S, Skou ST, Froelich A, Lotan I, Messina S, Geraldes R, Asseyer S, Stiebel-Kalish H, Oertel FC, Shaygannejad V, Sahraian MA, Kim HJ, Bennett JL, Böttcher C, Zimmermann HG, Weinshenker BG, Paul F, and Asgari N
Subjects: Humans, Prospective Studies, Male, Female, Myelin-Oligodendrocyte Glycoprotein immunology, Adult, Biomarkers blood, Autoantibodies blood, Autoantibodies immunology, Middle Aged, Multiple Sclerosis epidemiology, Multiple Sclerosis immunology, Comorbidity, Neuromyelitis Optica epidemiology, Neuromyelitis Optica immunology, Neuromyelitis Optica diagnosis
Abstract: Comorbidities in patients with multiple sclerosis (MS) and antibody-mediated diseases of the central nervous system (CNS) including neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein (MOG)-antibody-associated disease (MOGAD) are common and may influence the course of their neurological disease. Comorbidity may contribute to neuronal injury and therefore limit recovery from attacks, accelerate disease progression, and increase disability. This study aims to explore the impact of comorbidity, particularly vascular comorbidity, and related risk factors on clinical and paraclinical parameters of MS, NMOSD and MOGAD. We propose COMMIT, a prospective multicenter study with longitudinal follow-up of patients with MS, NMOSD, and MOGAD, with or without comorbidities, as well as healthy subjects as controls. Subjects will be stratified by age, sex and ethnicity. In consecutive samples we will analyze levels of inflammation and neurodegeneration markers in both fluid and cellular compartments of the peripheral blood and cerebrospinal fluid (CSF) using multiple state-of-the-art technologies, including untargeted proteomics and targeted ultrasensitive ELISA assays and quantitative reverse transcription polymerase chain reaction (RT-qPCR) as well as high-dimensional single-cell technologies i.e., mass cytometry and single-cell RNA sequencing. Algorithm-based data analyses will be used to unravel the relationship between these markers, optical coherence tomography (OCT) and magnetic resonance imaging (MRI), and clinical outcomes including frequency and severity of relapses, long-term disability, and quality of life. The goal is to evaluate the impact of comorbidities on MS, NMOSD, and MOGAD which may lead to development of treatment approaches to improve outcomes of inflammatory demyelinating diseases of the CNS., Competing Interests: STS as received personal fees from Munksgaard, TrustMe-Ed, and Nestlé Health Science outside the submitted work; is a co-founder of GLA:D®, a not-for-profit initiative hosted at the University of Southern Denmark aimed at implementing clinical guidelines for osteoarthritis in clinical practice; and has received a program grant from Region Zealand Exercise First and two grants from the European Union’s Horizon 2020 research and innovation program, one from the European Research Council MOBILIZE, grant agreement No. 801790 and the other under grant agreement No. 945377 ESCAPE. ML has received consulting fees and research grants from Alexion AstraZeneca, Horizon Amgen, and Genentech Roche. AP has received grant support for remyelination trials in multiple sclerosis from the Amsterdam University Medicam Centre, Department of Neurology, MS Centre RESTORE trial and UCL, London RECOVER trial and from Fight for Sight nimodipine in optic neuritis trial; has received royalties or licenses from UptoDate Wolters Kluwer on a book chapter and speaker fees from the Heidelberg Academy; has participated in the Advisory Board SC Zeiss OCTA Angi-Network; is the chairman of ERN-EYE Neuro-ophthalmology until OCT-2020 and a board member of the National Dutch Neuro-ophthalmology Association; and has received equipment OCTA from Zeiss Plex Elite. JP has received support for scientific meetings and honorariums for advisory work from Merck Serono, Novartis, Chugai, Alexion, Roche, Medimmune, Argenx, UCB, Mitsubishi, Amplo, Janssen, and Sanofi; grants from Alexion, Roche, Medimmune, UCB, and Amplo Biotechnology; and patent ref P37347WO and license agreement Numares multimarker MS diagnostics shares in AstraZeneca. She also acknowledges partial funding from the highly specialized services of NHS England. SMe has received travel grants from Merck, Roche, and Sanofi and speaking honoraria from UCB. RG has received support for scientific meetings and courses and honoraria for advisory work from Bayer, Biogen, Merck, Novartis, and Jasen. EF has served on advisory boards for Alexion, Genentech, Horizon Therapeutics, and UCB. He has received speaker honoraria from Pharmacy Times and royalties from UpToDate. He was a site primary investigator in a randomized clinical trial on inebilizumab in neuromyelitis optica spectrum disorder run by Medimmune/Viela-Bio/Horizon Therapeutics. He has received funding from the NIH R01NS113828 and is a member of the medical advisory board of the MOG project and an editorial board member of the Journal of the Neurological Sciences and Neuroimmunology Reports. SMa has received speaker honoraria from Biogen, Novartis, Horizon, and Sanofi. SA has received speaker’s honoraria from Alexion, Bayer, and Roche. HS-K has received support for scientific meetings from Roche. FO has received grants from the National Multiple Sclerosis Society US, American Academy of Neurology, Hertie Foundation for Excellence in Clinical Neuroscience, and Novartis—all independent of this project. HK has received a grant from the National Research Foundation of Korea and research support from AprilBio, Eisai, and UCB; has received consultancy/speaker fees from Alexion, Altos Biologics, AstraZeneca, Biogen, Daewoong Pharmaceutical, Eisai, GC Pharma, Handok Pharmaceutical, Kaigene, Kolon Life Science, MDimune, Merck Serono, Mitsubishi Tanabe Pharma, Roche, and Sanofi Genzyme; and is a co-editor for the Multiple Sclerosis Journal and an associated editor for the Journal of Clinical Neurology. MS and VS has received educational research grants, lecture honorarium, and travel support to attend scientific meetings from Biogen-Idec, Merck, Bayer, Novartis, Cinnagen, Osveh, Zistdaru, Zahravi, Abidi, and NanoAvland. JB reported personal fees from Roche, Genentech, Horizon, Chugai Pharma, Clene Nanoscience, Reistone-Bio, Beigene, and Imcyse; grants and personal fees from Alexion; and grants from the National Institutes of Health. JB has a patent aquaporumab issued. CB has received a grant from Roche, unrelated to this study. HZ has received grants from Novartis, unrelated to this study. BW has received royalties from RSR Ltd, Oxford University, Hospices Civil de Lyon, and MVZ Labor PD Dr. Volkmann und Kollegen GbR for a patent of NMO-IgG as a diagnostic test for neuromyelitis optica spectrum disorders; served on the adjudication committee for clinical trials conducted by MedImmune/VielaBio, Alexion, and UCB Biosciences; and consulted for Chugai/Roche/Genentech, Horizon Therapeutics, Mitsubishi-Tanabe, and CANbridge Pharmaceuticals regarding neuromyelitis optica spectrum disorders. He has received honoraria for speaking at internal meetings of Genentech, Novartis, and Horizon and at external meetings for Roche. FP served on the scientific advisory boards of Novartis and MedImmune; received travel funding and/or speaker honoraria from Bayer, Novartis, Biogen, Teva, Sanofi-Aventis/Genzyme, Merck Serono, Alexion, Chugai, MedImmune, and Shire; is an associate editor of Neurology: Neuroimmunology & Neuroinflammation; is an academic editor of PLoS ONE; consulted for Sanofi Genzyme, Biogen, MedImmune, Shire, and Alexion; received research support from Bayer, Novartis, Biogen, Teva, Sanofi-Aventis/Genzyme, Alexion, and Merck Serono; and received research support from the German Research Council, Werth Stiftung of the City of Cologne, German Ministry of Education and Research, Arthur Arnstein Stiftung Berlin, EU FP7 Framework Program, Arthur Arnstein Foundation Berlin, Guthy-Jackson Charitable Foundation, and NMSS. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Samadzadeh, Adnan, Berglova, Barzegar, Debrabant, Roikjaer, Levy, Petzold, Palace, Flanagan, Mariotto, Skou, Froelich, Lotan, Messina, Geraldes, Asseyer, Stiebel-Kalish, Oertel, Shaygannejad, Sahraian, Kim, Bennett, Böttcher, Zimmermann, Weinshenker, Paul and Asgari.)
Published: 2024
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33. Experiences of integrating and sustaining physical activity in life with multiple sclerosis, Alzheimer's disease, and ischaemic heart disease: a scoping review.

Author: Roikjær SG, Skou ST, Walløe S, Tang LH, Beck M, Simonÿ C, and Asgari N
Subjects: Humans, Qualitative Research, Alzheimer Disease rehabilitation, Multiple Sclerosis rehabilitation, Exercise, Myocardial Ischemia rehabilitation, Myocardial Ischemia psychology
Abstract: Purpose: The effects of physical activity on health are well-established for chronic diseases such as multiple sclerosis (MS), Alzheimer's disease (AD), and ischaemic heart disease (IHD). However, sustaining physical activity in everyday life is difficult. Lifeworld knowledge can help qualify interventions aimed at resolving this public health issue, but there is a gap in regard to synthesized research on peoples' experiences with integrating and sustaining physical activity. Hence, the purpose of this review is to explore and present the available evidence on experiences with integrating and sustaining physical activity in a lived life with MS, AD, and IHD., Methods: We conducted a scoping review with qualitative analysis and narrative syntheses in accordance with PRISMA-ScR. Based on SPIDER we ran a systematic search in Cinahl, Embase, Medline, and PsychInfo for primary qualitative research papers published until December 2022., Results: 43 papers were included. A thematic content analysis found that individuals who have MS, AD or IHD find integrating and sustaining physical activity in everyday life meaningful on several levels: Physical activity can facilitate meaningful movement with outcomes of physical, psychosocial, and existential importance., Conclusion: The research literature presents a meaning to physical activity that extends the idea of physical fitness to one of existential movement and personal growth. In addition, our review finds that people are more likely to integrate and sustain physical activity if they feel acknowledged, supported and believe that physical activity has a meaningful purpose reflecting their sense of self. Taking a more person-centred approach in rehabilitative care might help qualify the content of physical activity in terms of integration into everyday life, but more research is needed on how to implement a person-centred approach in practice.
Published: 2024
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34. Association between widespread pain and psychosocial factors in people with knee osteoarthritis: a cross-sectional study of patients from primary care in Denmark.

Author: Peral Pérez J, Mortensen SR, Lluch Girbés E, Grønne DT, Thorlund JB, Roos EM, and Skou ST
Abstract: Introduction: The relationship between psychosocial factors and bodily pain in people with knee osteoarthritis (KOA) is unclear., Purpose: To examine whether widespread pain was associated with poorer self-efficacy, more anxiety, depression, and kinesiophobia in people with KOA., Methods: This was a cross-sectional study based on data from Good Life with osteoArthritis in Denmark (GLA:D®). The association between widespread pain (multiple pain sites) and self-efficacy (Arthritis Self-Efficacy Scale), anxiety and depression (item from the EQ-5D-5 L), and kinesiophobia (yes/no) was examined using multiple linear tobit or logistic regression models., Results: Among 19,323 participants, 10% had no widespread pain, 37% had 2 pain sites, 26% had 3-4 pain sites, and 27% had ≥5 pain sites. Widespread pain was associated with poorer self-efficacy (-0.9 to -8.3 points), and the association was stronger with increasing number of pain sites (p-value <.001). Significant increasing odds ratios (ORs) were observed for having anxiety or depression with 3-4 pain sites (OR 1.29, 95% CI 1.12; 1.49) and ≥5 pain sites (OR 1.80, 95% CI 1.56; 2.07). Having 2 and 3-4 pain sites were associated with lower odds of kinesiophobia compared to having no widespread pain., Conclusion: Widespread pain was associated with lower self-efficacy and more anxiety and depression but also lower kinesiophobia in people with KOA.
Published: 2024
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35. Patients' behaviour after referral to a wound care clinic for diabetic foot ulcer care: a grounded theory study.

Author: Aagaard TV, Skou ST, Brorson S, and Madsen UR
Subjects: Humans, Male, Female, Middle Aged, Aged, Ambulatory Care Facilities, Diabetic Foot therapy, Diabetic Foot psychology, Grounded Theory, Referral and Consultation
Abstract: Objective: The aim of this study was to construct a grounded theory regarding patients' activity behaviour over time after referral to an outpatient clinic for diabetic foot ulcer (DFU) care., Method: A constructivist grounded theory approach was used. Data from observations of and interviews with participants were collected and analysed using the constant comparative method. Based on this, the grounded theory 'Just a bump in the road' was constructed., Results: The cohort included five participants who considered their ulcers as 'Just a bump in the road' in their lives, and four subcategories were embedded in this core category: 'Restricting my freedom'; 'Trusting or doubting the system'; 'Feeling no pain or illness'; and 'Receiving insufficient information'. Together, these categories describe the participants' behaviour and underlying concerns related to daily activities after referral to an outpatient clinic for the care of their DFU., Conclusion: The grounded theory 'Just a bump in the road' describes how participants with a DFU viewed their condition as merely a passing phase that would end with them regaining what they considered a normal life. Integrating these results into clinical practice could lead to improved care and a focus shift among health professionals from viewing patients as being defined by their wounds to seeing them as people who live with a wound.
Published: 2024
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36. Do self-reported knee instability, difficulty twisting, and knee confidence change after exercise and education in patients with knee osteoarthritis?

Author: Selçuk H, Roos EM, Grønne DT, Thorlund JB, Sarı Z, and Skou ST
Subjects: Humans, Self Report, Knee Joint, Exercise, Exercise Therapy, Osteoarthritis, Knee therapy, Joint Instability
Published: 2024
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37. Are Outcomes From an Exercise Therapy and Patient Education Program for Osteoarthritis Associated With Hip and Knee Replacement Within Two Years? A Register-Based Study of 9,339 Patients With Osteoarthritis.

Author: Ackerman IN, Johansson MS, Grønne DT, Clausen S, Ernst MT, Overgaard S, Odgaard A, Roos EM, and Skou ST
Subjects: Humans, Male, Female, Aged, Middle Aged, Denmark epidemiology, Treatment Outcome, Quality of Life, Time Factors, Osteoarthritis, Knee surgery, Osteoarthritis, Knee therapy, Arthroplasty, Replacement, Knee, Osteoarthritis, Hip surgery, Registries, Exercise Therapy, Arthroplasty, Replacement, Hip, Patient Education as Topic
Abstract: Objective: The objective of this study was to determine whether short-term outcomes from exercise therapy and patient education for osteoarthritis (OA) are associated with hip or knee replacement within two years., Methods: Individual-level data from the Good Life with osteoArthritis in Denmark (GLA:D) Registry were linked to the Danish National Patient Registry and other national registries. Cox proportional hazards models were used to investigate associations between program outcomes (baseline to three-month changes) and time to primary hip or knee replacement. Patients who did not receive joint replacement were censored at two years, time of death, or emigration., Results: A total of 2,304 and 7,035 patients with clinically diagnosed hip and knee OA, respectively, were included. Of these, 30% with hip OA and 10% with knee OA had joint replacement within two years. Postprogram improvements in hip-related quality of life and arthritis self-efficacy (pain subscale) were associated with a reduced hazard of hip replacement (adjusted hazard ratios [HRs] for a 10-unit improvement: 0.74 [95% confidence interval (CI) 0.69-0.80] and 0.90 [95% CI 0.85-0.96], respectively). Improvements in knee pain, knee-related quality of life, and arthritis self-efficacy (pain subscale) were associated with a lower hazard of knee replacement (adjusted HRs for 10-unit improvement: 0.81 [95% CI 0.76-0.86] to 0.90 [95% CI 0.86-0.95], 0.70 [95% CI 0.63-0.78] to 0.79 [95% CI 0.72-0.86], and 0.89 [95% CI 0.83-0.94], respectively)., Conclusion: The magnitude of improvement in key measures after exercise therapy and education was significantly associated with the likelihood of surgery. Progression to hip replacement was three times higher than progression to knee replacement. This information can guide patient-clinician conversations around anticipated program outcomes., (© 2024 The Authors. Arthritis Care & Research published by Wiley Periodicals LLC on behalf of American College of Rheumatology.)
Published: 2024
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38. Benefits and harms of structured outdoor physical activity for people with somatic or mental diseases: A systematic review and meta-analysis.

Author: Ahler JR, Busk H, Holm PM, Bricca A, Poulsen DV, Skou ST, and Tang LH
Subjects: Humans, Randomized Controlled Trials as Topic, Exercise, Mental Disorders, Quality of Life
Abstract: Objective: To examine the benefits and harms of structured outdoor physical activity (PA) for people living with one or more somatic or mental diseases., Methods: We identified articles from inception until Marts 2023 in MEDLINE, EMBASE, CINAHL and CENTRAL and citation tracking in Web of Science. We included randomized controlled trials (RCTs) and observational studies examining structured outdoor PA reporting physical function, health-related quality of life (HRQOL), pain or mental outcomes. We used random-effect meta-analyses and investigated heterogeneity in subgroups, sensitivity and meta-regression analyses. Observational studies and studies with insufficient data were summarized narratively. Certainty of evidence was assessed with GRADE., Results: From 4098 hits, 20 studies (19 RCTs and 1 cohort) were included (n: 1759 participants). Studies varied in type of disease and intervention. End of intervention results suggested a small effect on HRQOL (k = 10, SMD = 0.45, 95%CI: 0.19 to 0.71) and physical function (k = 14, SMD = 0.39, 95%CI: 0.13 to 0.64), while effects were moderate on mental outcomes (k = 13, SMD = -0.52, 95%CI: -0.82 to -0.23) favoring the outdoor intervention over comparators (no intervention, usual care, indoor PA or outdoor intervention without exercise). We were not able to conclude on outdoor interventions' effect on pain. Four studies reported adverse events including non-serious (pain, falls, fatigue) and serious (hospitalization, pneumonia). Certainty of evidence was overall very low., Conclusion: Structured outdoor PA may improve HRQOL and physical function, as well as mental health outcomes. The very low certainty of evidence calls for high quality RCTs to determine benefits and harms of structured outdoor PA., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The authors declared the following potential conflict of interest: STS is co-founder of GLA:D®, a not-for profit initiative hosted at University of Southern Denmark aimed at implementing clinical guidelines for osteoarthritis in clinical practice. Furthermore, he has received personal fees from Munksgaard, TrustMe-Ed, and Nestlé Health Science, outside the work. AB has received personal fees from PhisioVit S.r.l. JRA, HB, PMH, DVP and LHT have no conflicts to declare., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Published: 2024
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39. "It has changed my picture of myself": how did females living with chronic pain perceive the impact of the standard pain rehabilitation, including the occupational therapy lifestyle intervention REVEAL(OT)?

Author: Nielsen SS, Christensen JR, Søndergaard J, Surrow S, Enemark Larsen A, Skou ST, and Simonÿ C
Subjects: Humans, Female, Middle Aged, Adult, Adaptation, Psychological, Qualitative Research, Life Style, Interviews as Topic, Activities of Daily Living, Health Behavior, Pain Management methods, Chronic Pain rehabilitation, Chronic Pain psychology, Occupational Therapy methods
Abstract: Purpose: This study investigated patient perceptions of multidisciplinary chronic pain rehabilitation, including the occupational therapy lifestyle management program REVEAL(OT), on everyday life with chronic pain., Methods: Individual interviews were conducted using video conferencing after completing multidisciplinary chronic pain rehabilitation. The interviews followed a semi-structured interview guide and investigated patient experiences with occupational therapy-supported health behavior transformation. The interviews were transcribed verbatim and analyzed iteratively using an inductive semantic data-driven approach inspired by Braun & Clarke's methodology., Results: Five females, 34 to 58 years old, revealed three common themes: To discover oneself anew; Increased energy and calmness; and Look into the future. The themes reflected transformations towards a healthier lifestyle through enhanced self-control, developing meaningful and secure everyday activities, and gaining reaffirmed dignity. The study also identified the participants' need for professional assistance to cope with the pain after discharge., Conclusions: Chronic pain rehabilitation that included an occupational therapy intervention supported health behavior transformation and chronic pain self-management in females, where meaningful daily occupations and physical activity played an important role. Individually tailored support, also available after chronic pain rehabilitation, would benefit the transformation process towards improved pain coping in females.Implications for rehabilitationPersonal gains for health and well-being may develop over a shorter or longer time after chronic pain rehabilitation.Targeting daily occupations and physical activity during chronic pain rehabilitation appears meaningful for females living with chronic pain.Progression from an individual to group approach can be relevant in planning chronic pain rehabilitation, but the individual capacities shall be considered.Male perspectives on chronic pain rehabilitation that includes focus on daily occupations and lifestyle need further investigation.
Published: 2024
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40. Co-designing municipal multimorbidity rehabilitation leveraging health literacy and social networks: Protocol for the CURIA study.

Author: Junge T, Pihl GT, Bak CK, and Skou ST
Abstract: Background: Managing multimorbidity poses significant challenges for individuals, their families, and society due to issues with health information comprehension, communication with healthcare providers, and navigating the healthcare system. These challenges emphasise the critical need to prioritize individual and organisational health literacy. Multimorbidity is associated with a lack of social support for health; however, social networks and community dynamics can enhance health literacy. The "Co-designing municipal rehabilitation" (CURIA) project targets enhancing individual and organisational health literacy, and social networks for individuals with multimorbidity, with the overall aim of addressing health inequity through a collaborative local co-design process involving stakeholders., Methods: The CURIA study employs a mixed-method approach that initially explores the health literacy experiences of individuals with multimorbidity participating in rehabilitation programs in selected Danish municipalities and the practices of professionals overseeing these programs. The subsequent co-design process will comprise individuals with multimorbidity, their relatives, municipalities, general practitioners, civil society, and knowledge institutions working together. This iterative and collaborative process involves tailoring and aligning health literacy needs with responsiveness within the context of local healthcare systems and developing supportive social networks., Discussion: Given the increasing burden of multimorbidity, there is an urgent need to develop evidence-based practice for multimorbidity rehabilitation practices, developed in collaboration with municipalities and civil society. Emphasising self-care support for individuals, managing complex rehabilitation needs, and involving individuals in intervention prioritisation and customisation are crucial aspects addressed by CURIA to enhance health literacy and align municipal rehabilitation with identified needs., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)
Published: 2024
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41. Early Surgery Versus Exercise Therapy and Patient Education for Traumatic and Nontraumatic Meniscal Tears in Young Adults-An Exploratory Analysis From the DREAM Trial.

Author: Damsted C, Skou ST, Hölmich P, Lind M, Varnum C, Jensen HP, Hansen MS, and Thorlund JB
Subjects: Humans, Adult, Male, Female, Young Adult, Adolescent, Arthroscopy, Meniscectomy, Time-to-Treatment, Tibial Meniscus Injuries therapy, Tibial Meniscus Injuries surgery, Tibial Meniscus Injuries rehabilitation, Exercise Therapy methods, Patient Education as Topic, Quality of Life
Abstract: OBJECTIVE: To compare the effect of early meniscal surgery versus exercise and education with the option of later surgery on pain, function, and quality of life in young patients with a meniscal tear, taking symptom onset into account. DESIGN: Randomized controlled trial. METHODS: In a randomized controlled trial (the "Danish RCT on Exercise versus Arthroscopic Meniscal surgery for young adults" [DREAM] trial), 121 patients aged 18-40 years with a magnetic resonance imaging-verified meniscal tear were randomized to surgery or 12 weeks of supervised exercise and patient education. For this exploratory study, the analyses were stratified by symptom onset (traumatic/nontraumatic). The main outcome was the difference in change after 12 months in the mean score of 4 Knee injury and Osteoarthritis Outcome Score subscales (KOOS 4 ) covering pain, symptoms, function in sport and recreation, and quality of life. RESULTS: Forty-two patients (69%) in the exercise therapy group and 47 (78%) in the surgery group were categorized as having a traumatic tear. We observed no difference in change in the KOOS 4 after 12 months between the 2 treatment groups for either traumatic tears (18.8 versus 16.0 in the surgery versus exercise therapy groups; adjusted mean difference, 4.8 [95% confidence interval, -1.7 to 11.2]) or nontraumatic tears (20.6 versus 17.3 in the surgery versus exercise therapy groups; adjusted mean difference, 7.0 [95% confidence interval, -3.7 to 17.7]). CONCLUSION: In patients with traumatic and nontraumatic meniscus tears, early meniscal surgery did not appear superior to exercise and education in improving pain, function, and quality of life after 12 months. Further research is needed to confirm the clinical applicability of these findings. J Orthop Sports Phys Ther 2024;54(5):1-10. Epub 22 February 2024. doi:10.2519/jospt.2024.12245 .
Published: 2024
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42. Total Knee Arthroplasty Versus Education and Exercise for Knee Osteoarthritis: A Propensity-Matched Analysis.

Author: Young JJ, Zywiel MG, Skou ST, Chandran V, Davey JR, Gandhi R, Mahomed NN, Syed K, Veillette CJH, Rampersaud YR, and Perruccio AV
Abstract: Objective: We estimate the treatment effect of total knee arthroplasty (TKA) versus an education and exercise (Edu+Ex) program on pain, function, and quality of life outcomes 3 and 12 months after treatment initiation for knee osteoarthritis (OA)., Methods: Patients with knee OA who had undergone TKA were matched on a 1:1 ratio with participants in an Edu+Ex program based on a propensity score fitted to a range of pretreatment covariates. After matching, between-group differences in improvement (the treatment effect) in Knee Injury and Osteoarthritis Outcome Score 12-item version (0, worst to 100, best) pain, function, and quality of life from baseline to 3 and 12 months were estimated using linear mixed models, adjusting for unbalanced covariates, if any, after matching., Results: The matched sample consisted of 522 patients (Edu+Ex, n = 261; TKA, n = 261) who were balanced on all pretreatment characteristics. At 12-month follow-up, TKA resulted in significantly greater improvements in pain (mean difference [MD] 22.8; 95% confidence interval [95% CI] 19.7-25.8), function (MD 21.2; 95% CI 17.7-24.4), and quality of life (MD 18.3; 15.0-21.6). Even so, at least one-third of patients receiving Edu+Ex had a clinically meaningful improvement in outcomes at 12 months compared with 75% of patients with TKA., Conclusion: TKA is associated with greater improvements in pain, function, and quality of life, but these findings also suggest that Edu+Ex may be a viable alternative to TKA in a meaningful proportion of patients, which may reduce overall TKA need. Confirmatory trials are needed., (© 2024 American College of Rheumatology.)
Published: 2024
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43. Progressive Resistance Training or Neuromuscular Exercise for Hip Osteoarthritis : A Multicenter Cluster Randomized Controlled Trial.

Author: Kjeldsen T, Skou ST, Dalgas U, Tønning LU, Ingwersen KG, Birch S, Holm PM, Frydendal T, Garval M, Varnum C, Bibby BM, and Mechlenburg I
Subjects: Humans, Female, Male, Middle Aged, Aged, Exercise Therapy methods, Single-Blind Method, Osteoarthritis, Hip rehabilitation, Osteoarthritis, Hip therapy, Osteoarthritis, Hip physiopathology, Resistance Training, Quality of Life
Abstract: Background: Exercise is recommended as first-line treatment for patients with hip osteoarthritis (OA). However, randomized controlled trials providing evidence for the optimal exercise type are lacking., Objective: To investigate whether progressive resistance training (PRT) is superior to neuromuscular exercise (NEMEX) for improving functional performance in patients with hip OA., Design: Multicenter, cluster-randomized, controlled, parallel-group, assessor-blinded, superiority trial. (ClinicalTrials.gov: NCT04714047)., Setting: Hospitals and physiotherapy clinics., Participants: 160 participants with clinically diagnosed hip OA were enrolled from 18 January 2021 to 28 April 2023 and randomly assigned to PRT ( n = 82) or NEMEX ( n = 78)., Intervention: Twelve weeks of PRT or NEMEX with 2 supervised 60-minute group sessions each week. The PRT intervention consisted of 5 high-intensity resistance training exercises targeting muscles at the hip and knee joints. The NEMEX intervention included 10 exercises and emphasized sensorimotor control and functional stability., Measurements: The primary outcome was change in the 30-second chair stand test (30s-CST). Key secondary outcomes were changes in scores on the pain and hip-related quality of life (QoL) subscales of the Hip Disability and Osteoarthritis Outcome Score (HOOS)., Results: The mean changes from baseline to 12-week follow-up in the 30s-CST were 1.5 (95% CI, 0.9 to 2.1) chair stands with PRT and 1.5 (CI, 0.9 to 2.1) chair stands with NEMEX (difference, 0.0 [CI, -0.8 to 0.8] chair stands). For the HOOS pain subscale, mean changes were 8.6 (CI, 5.3 to 11.8) points with PRT and 9.3 (CI, 5.9 to 12.6) points with NEMEX (difference, -0.7 [CI, -5.3 to 4.0] points). For the HOOS QoL subscale, mean changes were 8.0 (CI, 4.3 to 11.7) points with PRT and 5.7 (CI, 1.9 to 9.5) points with NEMEX (difference, 2.3 [CI, -3.0 to 7.6] points)., Limitation: Participants and physiotherapists were not blinded., Conclusion: In patients with hip OA, PRT is not superior to NEMEX for improving functional performance, hip pain, or hip-related QoL., Primary Funding Source: Independent Research Fund Denmark., Competing Interests: Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-3225.
Published: 2024
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44. It is like someone holding your hand when you need it - lived experiences of patients with cardiovascular disease participating in a digital health intervention focusing on the maintenance of physical activity after cardiac rehabilitation.

Author: Hamborg TG, Tang LH, Andersen RM, Skou ST, and Simonÿ C
Subjects: Adult, Aged, Female, Humans, Male, Middle Aged, Digital Health, Feasibility Studies, Motivation, Qualitative Research, Cardiac Rehabilitation, Cardiovascular Diseases, Exercise, Text Messaging
Abstract: Purpose: To explore patients with cardiovascular diseases' lived experiences of the support given by a text message intervention focusing on the maintenance of physical activity after supervised cardiac rehabilitation., Methods: In a qualitative study, participants from the feasibility trial FAIR were interviewed individually twice to disclose their lived experiences during and after the trial. Transcribed interviews were analysed based on a phenomenological-hermeneutic method, inspired by Paul Ricoeur's philosophy on narrative and interpretation., Results: Interviews of eight patients with cardiovascular disease (3 females, median age 57 years (range 37 to 74 years)) revealed two themes, The FAIR intervention as a bridge builder in the transition to being physically active in everyday life and Meaningful conditions for maintaining physical activity . Action plans guided physical activity, while text messages facilitated actions and left an impression of still being under supervision. A frame of reference with physical activity, family, being monitored, having to report back, and getting feedback, were incentives for being physically active., Conclusion: From a patient perspective, the text message intervention in the feasibility trial FAIR was valuable to support the maintenance of physical activity in the transition from a supervised exercise-based cardiac rehabilitation programme to everyday life on an individual basis. Participants experienced the intervention to hold their hands in changing behaviour and redefining themselves. Yet, there is an extended need for belonging and personal interactions in future interventions.
Published: 2024
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45. Exercise and Pain Neuroscience Education for Patients With Chronic Pain After Total Knee Arthroplasty: A Randomized Clinical Trial.

Author: Larsen JB, Skou ST, Laursen M, Bruun NH, Arendt-Nielsen L, and Madeleine P
Subjects: Humans, Female, Male, Aged, Middle Aged, Neurosciences education, Denmark, Pain, Postoperative etiology, Pain Measurement, Osteoarthritis, Knee surgery, Treatment Outcome, Pain Management methods, Arthroplasty, Replacement, Knee adverse effects, Arthroplasty, Replacement, Knee rehabilitation, Chronic Pain etiology, Exercise Therapy methods, Patient Education as Topic methods
Abstract: Importance: Up to 20% of patients develop chronic pain after total knee arthroplasty (TKA), yet there is a scarcity of effective interventions for this population., Objective: To evaluate whether neuromuscular exercise and pain neuroscience education were superior to pain neuroscience education alone for patients with chronic pain after TKA., Design, Setting, and Participants: A superiority randomized clinical trial was conducted at 3 outpatient clinics at Aalborg University Hospital in Denmark. Participants with moderate-to-severe average daily pain intensity and no signs of prosthesis failure at least 1 year after primary TKA were included. Participant recruitment was initiated on April 12, 2019, and completed on October 31, 2022. The 12-month follow-up was completed on March 21, 2023., Interventions: The study included 24 sessions of supervised neuromuscular exercise (2 sessions per week for 12 weeks) and 2 total sessions of pain neuroscience education (6 weeks between each session) or the same pain neuroscience education sessions alone. The interventions were delivered in groups of 2 to 4 participants., Main Outcomes and Measures: The primary outcome was change from baseline to 12 months using the mean score of the Knee Injury and Osteoarthritis Outcome Score, covering the 4 subscales pain, symptoms, activity of daily living, and knee-related quality of life (KOOS4; scores range from 0 to 100, with higher scores indicating better outcomes). The outcome assessors and statistician were blinded. All randomized participants were included in the intention-to-treat analysis., Results: Among the 69 participants (median age, 67.2 years [IQR, 61.2-71.9 years]; 40 female [58%]) included in the study, 36 were randomly assigned to the neuromuscular exercise and pain neuroscience education group, and 33 to the pain neuroscience education-alone group. The intention-to-treat analysis showed no between-group difference in change from baseline to 12 months for the KOOS4 (7.46 [95% CI, 3.04-11.89] vs 8.65 [95% CI, 4.67-12.63] points; mean difference, -1.33 [95% CI, -7.59 to 4.92]; P = .68). Among the 46 participants who participated in the 12-month assessment in the 2 groups, 16 (34.8%) experienced a clinically important improvement (a difference of ≥10 points on the KOOS4) with no between-group difference. No serious adverse events were observed., Conclusions and Relevance: In this randomized clinical trial, the results demonstrated that neuromuscular exercises and pain neuroscience education were not superior to pain neuroscience education alone in participants with chronic pain after TKA. Approximately one-third of the participants, regardless of intervention, experienced clinically important improvements. Future studies should investigate which patient characteristics indicate a favorable response to exercises and/or pain neuroscience education., Trial Registration: ClinicalTrials.gov Identifier: NCT03886259.
Published: 2024
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46. Effects of neuromuscular control and strengthening exercises on MRI-measured thigh tissue composition and muscle properties in people with knee osteoarthritis - an exploratory secondary analysis from a randomized controlled trial.

Author: Holm PM, Blankholm AD, Nielsen JL, Bandholm T, Wirth W, Wisser A, Kemnitz J, Eckstein F, Schrøder HM, Wernbom M, and Skou ST
Subjects: Humans, Thigh diagnostic imaging, Exercise Therapy, Quadriceps Muscle diagnostic imaging, Magnetic Resonance Imaging, Muscle Strength physiology, Osteoarthritis, Knee diagnostic imaging, Osteoarthritis, Knee therapy
Abstract: Objective: To investigate the effects of adding strength training to neuromuscular control exercises on thigh tissue composition and muscle properties in people with radiographic-symptomatic knee osteoarthritis (KOA)., Methods: In this exploratory secondary analysis of a randomized controlled trial, using a complete-case approach, participants performed 12 weeks of twice-weekly neuromuscular control exercise and patient education (NEMEX, n = 34) or NEMEX plus quadriceps strength training (NEMEX+ST, n = 29). Outcomes were MRI-measured inter- and intramuscular adipose tissue (InterMAT, IntraMAT), quadriceps muscle cross-sectional area (CSA), knee-extensor strength, specific strength (strength/lean CSA) and 30 s chair-stands. Between-group effects were compared using a mixed model analysis of variance., Results: At 12 weeks, responses to NEMEX+ST overlapped with NEMEX for all outcomes. Both groups reduced InterMAT (NEMEX+ST=25 %, NEMEX=21 %); between-group difference: 0.8cm 2 (95 % CI: -0.1, 1.7). NEMEX+ST decreased IntraMAT (2 %) and NEMEX increased IntraMAT (4 %); between-group difference 0.1 %-points (-0.3, 0.5). Both groups increased quadriceps CSA and lean CSA (CSA minus IntraMAT), improved knee-extensor strength and specific strength, and improved chair-stand performance with a trend towards greater effects in NEMEX+ST., Conclusion: Adding strength training to 12 weeks of neuromuscular control exercises provided largely similar effects to neuromuscular control exercises alone in decreasing InterMAT and IntraMAT, in improving knee-extensor strength, CSA and in improving performance-based function in KOA persons, with a trend towards greater effects with additional strength training. Notably, both groups substantially reduced InterMAT and improved specific strength (an index of muscle quality). Our hypothesis-generating work warrants exploration of the roles played by InterMAT and IntraMAT in exercise effects in KOA., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Skou is associate editor of the Journal of Orthopaedic and Sports Physical Therapy, has received personal fees from Munksgaard, TrustMe-Ed, and Nestlé Health Science, outside the submitted work, and is co-founder of GLA:D®, a not-for profit initiative hosted at University of Southern Denmark aimed at implementing clinical guidelines for osteoarthritis in clinical practice. Dr. Bandholm has received speaker's honoraria for talks or expert testimony on the efficacy of exercise therapy to enhance recovery after surgery at meetings or symposia held by biomedical companies (Zimmer Biomet and Novartis). He is an editorial board member with British Journal of Sports Medicine. Dr. Wirth is a part time employee and co-owner of Chondrometrics GmbH. Wisser is an employee of Chondrometrics GmbH. Dr. Kemnitz is an employee of Siemens. Dr. Eckstein is CEO/CMO and co-owner of Chondrometrics GmbH, and he has provided consulting services to Merck KGaA, Samumed, Tissuegene, Servier, Galapagos and Roche. He also has received speaker honoraria from Medtronic., (Copyright © 2024. Published by Elsevier Inc.)
Published: 2024
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47. One-year effectiveness of high-load compared with low-load strengthening exercise on self-reported function in patients with hypermobile shoulders: a secondary analysis from a randomised controlled trial.

Author: Liaghat B, Juul-Kristensen B, Faber DA, Christensen EO, Søgaard K, Skou ST, Søndergaard J, and Juhl CB
Subjects: Adult, Humans, Female, Male, Shoulder Pain therapy, Shoulder, Self Report, Quality of Life, Exercise Therapy adverse effects, Joint Instability etiology, Shoulder Joint
Abstract: Objectives: To investigate the long-term effectiveness of high-load versus low-load strengthening exercise on self-reported function in patients with hypermobility spectrum disorder (HSD) and shoulder symptoms., Methods: A secondary analysis of a superiority, parallel-group, randomised trial (balanced block randomisation 1:1, electronic concealment) including adult patients (n=100) from primary care with HSD and shoulder pain and/or instability ≥3 months. Patients received 16 weeks of shoulder exercises (three sessions/week): HEAVY (n=50, full-range, high-load, supervised twice/week) or LIGHT (n=50, neutral/mid-range, low-load, supervised three times in total). The 1-year between-group difference in change in self-reported function was measured using the Western Ontario Shoulder Instability Index (WOSI, scale 0-2100, 0=best). Secondary outcomes were self-reported measures including changes in shoulder-related symptoms, function, emotions and lifestyle, quality of life, patient-perceived effect, treatment utility and adverse events. A blinded analyst conducted the analyses using linear mixed model repeated measurements analysis., Results: One-year data were available in 86 out of 100 participants (79% women, mean age 37.8 years) (LIGHT 84%, HEAVY 88%). The mean WOSI score between-group difference favoured HEAVY (-92.9, 95% CI -257.4 to 71.5, p=0.268) but was not statistically significant. The secondary outcomes were mostly inconclusive, but patients in HEAVY had larger improvement in the WOSI emotions subdomain (-36.3; 95% CI -65.4 to -7.3, p=0.014). Patient-perceived effect favoured HEAVY anchored in WOSI-emotions (55% vs 31%, p=0.027) and WOSI-lifestyle (50% vs 29%, p=0.042)., Conclusion: High-load shoulder strengthening exercise was not superior to low-load strengthening exercise in improving self-reported function at 1 year. High-load strengthening exercise may be more effective in improving patient emotions about shoulder pain and function, but more robust data are needed to support these findings., Trial Registration Number: NCT03869307., Competing Interests: Competing interests: STS is associate editor of Journal of Orthopaedic & Sports Physical Therapy, reports personal fees from Munksgaard, Nestlé Health Science and TrustMe-Ed, outside the submitted work, and being a co-founder of Good Life with osteoArthritis in Denmark (GLA:D). GLA:D is a non-profit initiative hosted at the University of Southern Denmark aimed at implementing clinical guidelines for osteoarthritis in clinical practice. JS reports receiving grants from Astra-Zeneca, outside the submitted work., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Published: 2024
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48. mHealth intervention including text messaging and behaviour change techniques to support maintenance of physical activity after cardiac rehabilitation: A single-arm feasibility study.

Author: Hamborg TG, Andersen RM, Skou ST, Clausen MB, Jäger M, Zangger G, Simonÿ C, Grøntved A, Brønd JC, Soja AMB, and Tang LH
Abstract: Objective: To evaluate the feasibility of a mobile health-supported intervention in patients with cardiovascular diseases after completion of a cardiac rehabilitation programme., Methods: The feasibility study was performed in two hospitals and one municipality in Region Zealand, Denmark. Eligible participants were ≥18 years old, participated in a supervised cardiac rehabilitation programme, had access to a mobile phone, and could walk 3 m independently. Participants received a 12-week intervention utilizing behaviour change techniques, consisting of action planning, text messages, and phone support. Feasibility was assessed using pre-defined progression criteria, which included recruitment (≥75%), retention (≥80%), accelerometer data completeness (≥80%), coordinator (phone support) time (≤30 min), the response rate on patient-reported outcomes (≥90%), adherence (≥75% respond to ≥75% of messages), and acceptability (≥75%). The secondary outcome of objective physical activity was assessed with accelerometers., Results: Ten women and 30 men with cardiovascular diseases aged 63.5 (±9.8 SD) participated. The progression criteria for retention (90%), accelerometer data completeness (83%), coordinator time (9.9 min), adherence (83%), and acceptability (82%) were at acceptable levels, exceptions were progression criteria for recruitment (35%) being below acceptable levels for recruitment, and response rate on patient-reported outcomes (75%). High satisfaction (92.6%) with the intervention was found. All objectively measured physical activity levels remained unchanged from baseline to follow-up. No serious adverse events related to the intervention were reported., Conclusion: Mobile health-supported maintenance of physical activity after cardiac rehabilitation completion was feasible, safe, and acceptable. Yet, changes to improve recruitment and response rate are needed before conducting a large-scale effect evaluation., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)
Published: 2024
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49. Searching for a brighter future-Lived experiences of ongoing recovery processes following COVID-19 infection.

Author: Andersen IC, Nissen N, Agerskov H, Beck M, Bodtger U, Tang L, Skou ST, and Simonÿ C
Subjects: Male, Humans, Female, Qualitative Research, Hermeneutics, Longitudinal Studies, Cognition, COVID-19
Abstract: Background: Research in Denmark indicates that approximately 30% of people with confirmed COVID-19 infection experience at least one physical symptom 6-12 months after the acute infection. The lived experiences of undergoing prolonged recovery processes and how these processes unfold need further attention., Aim: To contribute in-depth knowledge about recovery, as experienced over time by people living with the post COVID-19 condition., Methods: Within a qualitative research design, nine women and six men were interviewed. Ten of them gave a follow-up interview. Prompt cards and participant-generated photographs were included. A phenomenological-hermeneutic approach inspired by Ricoeur's theory of interpretation guided the data analysis., Findings: Living with long-term health problems associated with the post COVID-19 condition involved recovery processes where participants struggled with reduced capacity, new unpredictability and uncertainty in everyday life. Participants continuously searched for improvement and aimed for regaining former health and well-being. Lack of knowledge, acknowledgement and support made it difficult to find clear directions for improvement. Participants created a protective shield and struggled, often jointly with family and friends, to cope with bodily, cognitive, emotional, existential and social challenges. Over time, some participants realised that they might not be able to fully return to their earlier habitus. However, some of them gained a new foothold and sense of hope for the future., Conclusion: This study provides in-depth insight into the experience of changing and open-ended recovery processes while living with the post COVID-19 condition. Over time, some participants learned to rebuild their lives, adapting to their reduced capacities. Future care and rehabilitation models for these patients must address the complex and challenging nature of recovery processes associated with living with post-COVID-19 condition., (© 2023 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.)
Published: 2024
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50. Mapping interventional components and behavior change techniques used to promote self-management in people with multimorbidity: a scoping review.

Author: Jäger M, Zangger G, Bricca A, Dideriksen M, Smith SM, Midtgaard J, Taylor RS, and Skou ST
Subjects: Humans, Patient-Centered Care methods, Behavior Therapy, Multimorbidity, Self-Management
Abstract: Ageing populations and improved survival, have contributed to a rise in the number of people living with multimorbidity, raising issues related to polypharmacy, treatment burden, competing priorities and poor coordination of care. Self-management programs are increasingly included as an essential component of interventions to improve outcomes in this population. However, an overview of how interventions supporting self-management in patients with multimorbidity is missing. This scoping review focused on mapping the literature on patient-centered interventions for people living with multimorbidity. We searched several databases, clinical registries, and grey literature for RCTs published between 1990-2019 describing interventions that supported self-management in people with multimorbidity. We included 72 studies that were found to be very heterogeneous when it comes to the population, delivery modes and modalities, intervention elements and facilitators. The results pointed to an extensive use of cognitive behavioral therapy as a basis for interventions, as well as behavior change theories and disease management frameworks. The most coded behavior change techniques stemmed from the categories Social Support, Feedback and monitoring and Goals and Planning. To allow for implementation of effective interventions in clinical practice, improved reporting of intervention mechanisms in RCTs is warranted.
Published: 2024
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